Abstract
A 27-year-old housewife with acute lymphocytic leukemia was brought to complete remission (CR) with the combination of L-asparaginase (A-ase), vincristine (VCR) and prednisolone. Allergic reactions (uriticaria and dyspnea) which appeared at the beginning of the second course therapy were promptly relieved with the high dose hydrocortisone. she was maintained with VCR, endoxan (EX), 6-mercaptopurine (6-MP) and prednisolone. After 11 months of CR, her leukemia relapsed. High dose methotrexate therapy was ineffective. Combination of A-ase, VCR and prednisolone was started again and proved to be effective in the reduction of leukemia cells. The severe uriticaria appeared soon after the A-ase administration of the second course. A-ase was stopped and it disappered. Plasma exchange by IBM 2997 Blood Cell Processor was attempted to remove the anti-A-ase antibody. Seven thousands ml of plasma were exchanged for three consecutive days. This therapeutic procedure brought about striking decrease of the anti-A-ase titer and disappearance of allergic reactions to A-ase. CR was obtaind once again with combiation of A-ase, VCR, EX and prednisolone.
