A study on the risk factors of L-asparaginase

hypersensitivity reaction in pediatric patients

Chan-Mee Chung°, Yu-Jin Kang, Jae-Youn Kim, Young-Cheon Song

Department of Pharmacy, Asan Medical Center

L-asparaginase is frequently used in front-line treatment of pediatric ALL.

HSR(hypersensitivity reaction) against the drug is sometimes fatal. However, risk factors of L-asparaginase HSR were not studied well yet. A retrospective study was performed on 146 children(90boys, 56girls) who had treated with L-asparaginase in Asan Medical Center, Dept. of pediatric hemato-oncology during 2004~2006. Characteristics of reactive patients and risk factors of HSR were investigated. One patient was excluded because he had multiple positive skin test results and switched to PEG-asparaginase. 23 of 145(15.9) patients had HSR. It occurred most frequently at 10th dose, 60,000IU/m2 cumulative dose and the average interval between the causative dose and prior one was 65(range 0-794)days. Chi-square test proved sex-related difference of incidence between boys(16.9) and girls(14.3) was not statistically significant. Younger(<6YO) patients(11.4) and older(≥6YO) ones(20) had not-significant difference on incidence. Incidence on Obese(>95 BMI percentile), overweight(85~95), normal(<85)patients were 21.1, 12.5, 15.7 and also not significantly different. Patients with positive skin test had 21.7 incidence and it was significantly(p=0.03) higher than those with negative result(2.5). History of HSR was a statistically significant(p=0.03) risk factor because patients with history(35.7) had much higher incidence than those without history(11.1). There are limitations in this study, numerical difference of reactive patients and nonreactive ones ruined statistical power. Also, variations in dose schedule and concurrent illness biased result. Further studies are necessary to identify risk factors of L-asparaginase HSR that could adjust treatment plan.