Do immunoglobulin G and immunoglobulin E anti-l-asparaginase antibodies have distinct implications in children with acute lymphoblastic leukemia? A cross-sectional study

• Published in: Revista brasileira de hematologia e hemoterapia 2017-07, Vol.39 (3), p.202-209
• Main Authors: Galindo-Rodríguez, Gabriela, Jaime-Pérez, José C., Salinas-Carmona, Mario C., González-Díaz, Sandra N., Castro-Corona, Ángeles, Cavazos-González, Raúl, Treviño-Villarreal, Humberto, Heredia-Salazar, Alberto C., Gómez-Almaguer, David
• Format: Article
• Language: English
• Subjects: Acute lymphoblastic leukemia; Allergy; HEMATOLOGY; Hypersensitivity; l-Asparaginase; MEDICINE, RESEARCH & EXPERIMENTAL; Neutralizing antibodies; Original; Silent antibodies
• ISSN: 1516-8484; 1806-0870; 1806-0870
• DOI: 10.1016/j.bjhh.2016.11.006

l-Asparaginase is essential in the treatment of childhood acute lymphoblastic leukemia. If immunoglobulin G anti-l-asparaginase antibodies develop, they can lead to faster plasma clearance and reduced efficiency as well as to hypersensitivity reactions, in which immunoglobulin E can also participate. This study investigated the presence of immunoglobulin G and immunoglobulin E anti-l-asparaginase antibodies and their clinical associations. Under 16-year-old patients at diagnosis of B-cell acute lymphoblastic leukemia confirmed by flow cytometry and treated with a uniform l-asparaginase and chemotherapy protocol were studied. Immunoglobulin G anti-l-asparaginase antibodies were measured using an enzyme-linked immunosorbent assay. Intradermal and prick skin testing was performed to establish the presence of specific immunoglobulin E anti-l-asparaginase antibodies in vivo. Statistical analysis was used to investigate associations of these antibodies with relevant clinical events and outcomes. Fifty-one children were studied with 42 (82.35%) having anti-l-asparaginase antibodies. In this group immunoglobulin G antibodies alone were documented in 10 (23.8%) compared to immunoglobulin E alone in 18 (42.8%) patients. Immunoglobulin G together with immunoglobulin E were simultaneously present in 14 patients. Children who produced exclusively immunoglobulin G or no antibodies had a lower event-free survival (p-value=0.024). Eighteen children (35.3%) relapsed with five of nine of this group who had negative skin tests suffering additional relapses (range: 2–4), compared to none of the nine children who relapsed who had positive skin tests (p-value