左旋门冬酰胺酶脱敏法治疗急性淋巴细胞白血病

Acute Lymphocyte Leukemia Treated with L-Asparaginase Desensitization Therapy in Children

目的研究左旋门冬酰胺酶(L-Asp)脱敏法治疗儿童ALL的可行性,具体操作方法的改进及长期疗效。方法对ALL患儿中L-Asp皮试阳性或在应用过程中出现荨麻疹、呼吸困难等严重过敏反应者,用输液泵控制速度进行L-Asp脱敏治疗。结果 22例ALL患儿中35例次实施了L-Asp脱敏治疗,2例脱敏失败,33例次脱敏顺利,其中12例进行了2次、5例进行3次L-Asp脱敏治疗,均未出现严重过敏反应及相关不良反应。6例患儿于1、2次脱敏后皮试由阳性转为阴性。22例患儿随访2～38个月,21例均处于完全缓解状态,8例已完成化疗,处于停药观察中。L-Asp脱敏总剂量由10000U.m-2减为5000U.m-2,并用输液泵代替人工静脉推注。结论 L-Asp脱敏治疗更加安全、可靠、简便。多数患儿第2、3次脱敏反应更为轻微,随着脱敏次数的增加,L-Asp皮试转阴的病例逐步增加。可以使L-Asp更广泛地应用于ALL的化疗,对ALL患儿的长期缓解、防止复发具有重要作用。

Objective To explore the feasibility,improvement of the clinical manipulation and a long-term effect of L-asparaginase（L-Asp） desensitization therapy on acute lymphocyte leukemia（ALL） in children.Methods For ALL children with L-Asp skin test positive or with hives,dyspnea or other allergic signs,infusion pumps were used to control transfusion speed for L-Asp desensitization.Results Thirty-five times of L-Asp desensitization therapy were carried out in all 22 cases,of which 2 cases failed,33 times were accomplished smoothly,and second desensitization therapy was conducted in 12 cases,while the third was conducted in 5 cases without dyspnea and hives or adverse reactions.Six cases with positive L-Asp skin test were converted to negative by desensitization therapy,and the patients were followed up for 2 to 38 months.Of all the 22 cases,21 children had achieved remission and 8 children successfully accomplished the chemotherapy plan.The total dose of 10 000 U·m^-2L-Asp were given to 5 000 U·m^-2 and L-Asp desensitization therapies were proved to be secure and effective and safe.Conclusions The portable infusion pump can control transfusion speed in therapy.The side effects were well tolerable in most cases during the second and third desensitization therapy;with more and more desensitization therapies,more cases with previously positive SPT were converted to negative.L-Asp desensitization therapy may be used in ALL chemotherapy.It helps to keep a long-term disease-free survival and prevent leukemia relapse.