Narazaki Hidehiko, Kaizu Kiyohiko, Miyatake Chiharu, Koizumi Shinya, Asano Takeshi, Fujino Osamu
Department of Pediatrics, Chiba Hokusoh Hospital, Nippon Medical School, Inzai, Chiba, Japan.
J Nippon Med Sch. 2012;79(6):489-93. doi: 10.1272/jnms.79.489.
L-asparaginase (L-Asp) is an important reagent for acute lymphoblastic leukemia because asparagine is required for the malignant growth of tumor cells, especially lymphoblastic leukemia cells. An allergic response to L-Asp is not unusual because L-Asp is derived from Escherichia coli and is often recognized as a foreign protein. The hypersensitivity induced by L-Asp is of the immediate type in most cases. We report on a 5-year-old girl who was hospitalized for precursor T-cell lymphoblastic leukemia. She was treated according to a Tokyo Children's Cancer Study Group protocol (TCCSG ALL L09-1603 HEX/BFM). During the intensification phase, blisters with erythema developed on the arm proximal to the catheter insertion site owing to a delayed-type hypersensitivity reaction caused by intravenous L-Asp administration. She was treated with additional methylprednisolone, tapered dexamethasone, and an antihistamine for the allergic reaction. No asparaginases other than E. coli L-Asp have been approved for use in Japan. Other asparaginases, such as polyethylene glycol L-Asp and Erwinia L-Asp should be quickly approved for use as alternative chemotherapy reagents in Japan.
左旋天冬酰胺酶（L-Asp）是治疗急性淋巴细胞白血病的一种重要试剂，因为天冬酰胺是肿瘤细胞尤其是淋巴细胞白血病细胞恶性生长所必需的。对L-Asp产生过敏反应并不罕见，因为L-Asp来源于大肠杆菌，常被视为外来蛋白质。在大多数情况下，L-Asp引起的超敏反应属于速发型。我们报告了一名5岁因前体T细胞淋巴细胞白血病住院的女孩。她按照东京儿童癌症研究组方案（TCCSG ALL L09-1603 HEX/BFM）接受治疗。在强化治疗阶段，由于静脉注射L-Asp引起迟发型超敏反应，在靠近导管插入部位的手臂上出现了伴有红斑的水疱。她接受了额外的甲泼尼龙、逐渐减量的地塞米松以及用于过敏反应的抗组胺药治疗。在日本，除了大肠杆菌L-Asp外，没有其他天冬酰胺酶被批准使用。其他天冬酰胺酶，如聚乙二醇L-Asp和欧文氏菌L-Asp，应尽快在日本被批准用作替代化疗试剂。
