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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 study the feasibility of L-asp desensitization in children with ALL, and to improve the specific operation method and long-term efficacy. Methods L-Asp skin test in ALL children with positive or in the process of application of urticaria, dyspnea and other serious allergic reactions, with infusion pump control L-Asp desensitization treatment. Results Twenty-five cases of ALL children underwent L-Asp desensitization treatment. Two cases failed desensitization and 33 cases were desensitized smoothly. Twelve of them were performed twice and five cases of L-Asp desensitization Treatment, no serious allergic reaction and related adverse reactions. 6 cases of children after 1,2 times desensitized skin test from positive to negative. Twenty-two children were followed up for 2 ~ 38 months. All 21 patients were in complete remission and 8 patients had completed chemotherapy. The total dose of L-Asp desensitization was reduced from 10000U.m-2 to 5000U.m-2, and infusion pump instead of artificial intravenous injection. Conclusion L-Asp desensitization is safer, more reliable and more convenient. The second and third desensitization reactions in most children were more minor. With the increase of desensitization frequency, the cases of negative L-Asp skin test gradually increased. L-Asp can be more widely used in the chemotherapy of ALL, children with long-term remission, to prevent recurrence has an important role.