Platinum desensitization in patients with carboplatin hypersensitivity: A single-institution retrospective study

Gary Altwerger, Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA. Electronic address: gary.altwerger@yale.edu.
Gregory M. Gressel, Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA.
Diana P. English, Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA.
Wendelin K. Nelson, Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA.
Nina Carusillo, Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA.
Dan-Arin Silasi, Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA.
Masoud Azodi, Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA.Follow
Alessandro Santin, Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA.
Peter E. Schwartz, Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA.
Elena S. Ratner, Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA.

Document Type

Article

Publication Title

Gynecologic oncology

Abstract

OBJECTIVES: The carboplatin desensitization (CD) protocol presented here allows patients with either a positive skin test or a prior hypersensitivity reaction (HSR) to safely, rapidly and effectively continue with carboplatin infusions. Newly described factors can identify patients at risk for developing adverse events during CD. METHODS: A retrospective review was performed on patients with gynecologic cancer who underwent CD between 2005 and 2014. The CD protocol uses a four-step dilution process over 3.5h. RESULTS: 129 patients underwent CD and completed a total of 788cycles. The desensitization protocol prevented HSRs in 96% (753 out of 788) of these cycles. Patients achieved an average of 6.1cycles (SD±4.55, range 0-23) with CD. The CD protocol allowed 73% (94 of 129) of the patients to undergo carboplatin infusion without reaction. Patients with moderate to life-threatening HSRs (grade 2 through 4) were 10.5years younger at initial CD than patients with grades 0 or 1 HSRs (52.3 vs. 63, P = 0.0307). One patient death occurred during her thirteenth desensitization cycle. The HSR in this case was complicated by pre-exisiting pulmonary hypertension. CONCLUSIONS: This is the largest study of its kind showing a safe, effective and rapid (3.5h) CD protocol. The majority of patients with a history of either carboplatin hypersensitivity reaction or a positive skin test completed the CD protocol without HSRs. Age was identified as a risk factor for HSR severity during CD. Age can be employed along with pre-load dependent cardiac conditions as a way to help risk stratify patients undergoing CD.

First Page

77

Last Page

82

DOI

10.1016/j.ygyno.2016.09.027

Publication Date

1-1-2017

Identifier

27789084 (pubmed); 10.1016/j.ygyno.2016.09.027 (doi); S0090-8258(16)31433-0 (pii)

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