Development of anti‐asparaginase antibodies in childhood acute lymphoblastic leukemia

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Abstract
L‐asparaginase is a basic agent of antileukemic therapy, but allergic reactions against the drug and the development of anti‐asparaginase antibodies are significant side‐effects. The aim of our study was to estimate the presence of anti‐asparaginase antibodies and to correlate the results with clinically apparent allergic reactions and with L‐asparaginase activity during the treatment. We examined 13 children with newly diagnosed acute lymphoblastic leukemia (ALL), treated according to the Polish Pediatric Leukemia/Lymphoma Group protocol, based on ALL‐BFM 95. Enzyme activity was estimated in serum samples, collected before each L‐asparaginase administration, using the photometrical method. Anti‐asparaginase antibody concentration was measured by enzyme‐linked immunosorbent assay (ELISA) at the two time points: at the last day of L‐asparaginase treatment in the induction and the reinduction phase. The mean L‐asparaginase activity was 273 IU/L in the induction phase; no anti‐asparaginase antibodies in this phase of treatment were found. The mean L‐asparaginase activity was 425 IU/L in the reinduction phase of treatment; in five children anti‐asparaginase antibodies were detected. In four of these five children low L‐asparaginase activity and/or allergic reactions against L‐asparaginase were noted. Our observations suggest a correlation between the presence of anti‐asparaginase antibodies and L‐asparaginase activity in childhood ALL.