Platinum desensitization in patients with carboplatin hypersensitivity: A single-institution retrospective study
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
Recommended Citation
Altwerger, Gary; Gressel, Gregory M.; English, Diana P.; Nelson, Wendelin K.; Carusillo, Nina; Silasi, Dan-Arin; Azodi, Masoud; Santin, Alessandro; Schwartz, Peter E.; and Ratner, Elena S., "Platinum desensitization in patients with carboplatin hypersensitivity: A single-institution retrospective study" (2017). Obstetrics and Gynecology. 163.
https://scholar.bridgeporthospital.org/obgyn/163
Identifier
27789084 (pubmed); 10.1016/j.ygyno.2016.09.027 (doi); S0090-8258(16)31433-0 (pii)