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

Gary Altwerger, Gregory M. Gressel, Diana P. English, Wendelin K. Nelson, Nina Carusillo, Dan Arin Silasi, Masoud Azodi, Alessandro Santin, Peter E. Schwartz, Elena S. Ratner

Research output: Contribution to journalArticle

11 Citations (Scopus)

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 3.5 h. Results 129 patients underwent CD and completed a total of 788 cycles. The desensitization protocol prevented HSRs in 96% (753 out of 788) of these cycles. Patients achieved an average of 6.1 cycles (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 10.5 years 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 (3.5 h) 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.

Original languageEnglish (US)
Pages (from-to)77-82
Number of pages6
JournalGynecologic Oncology
Volume144
Issue number1
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Fingerprint

Carboplatin
Platinum
Hypersensitivity
Retrospective Studies
Skin Tests
Pulmonary Hypertension

Keywords

  • Allergy to carboplatin
  • Carboplatin desensitization
  • Gynecologic malignancy
  • Hypersensitivity reactions

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Platinum desensitization in patients with carboplatin hypersensitivity : A single-institution retrospective study. / Altwerger, Gary; Gressel, Gregory M.; English, Diana P.; Nelson, Wendelin K.; Carusillo, Nina; Silasi, Dan Arin; Azodi, Masoud; Santin, Alessandro; Schwartz, Peter E.; Ratner, Elena S.

In: Gynecologic Oncology, Vol. 144, No. 1, 01.01.2017, p. 77-82.

Research output: Contribution to journalArticle

Altwerger, G, Gressel, GM, English, DP, Nelson, WK, Carusillo, N, Silasi, DA, Azodi, M, Santin, A, Schwartz, PE & Ratner, ES 2017, 'Platinum desensitization in patients with carboplatin hypersensitivity: A single-institution retrospective study', Gynecologic Oncology, vol. 144, no. 1, pp. 77-82. https://doi.org/10.1016/j.ygyno.2016.09.027
Altwerger, Gary ; Gressel, Gregory M. ; English, Diana P. ; Nelson, Wendelin K. ; Carusillo, Nina ; Silasi, Dan Arin ; Azodi, Masoud ; Santin, Alessandro ; Schwartz, Peter E. ; Ratner, Elena S. / Platinum desensitization in patients with carboplatin hypersensitivity : A single-institution retrospective study. In: Gynecologic Oncology. 2017 ; Vol. 144, No. 1. pp. 77-82.
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T2 - A single-institution retrospective study

AU - Altwerger, Gary

AU - Gressel, Gregory M.

AU - English, Diana P.

AU - Nelson, Wendelin K.

AU - Carusillo, Nina

AU - Silasi, Dan Arin

AU - Azodi, Masoud

AU - Santin, Alessandro

AU - Schwartz, Peter E.

AU - Ratner, Elena S.

PY - 2017/1/1

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N2 - 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 3.5 h. Results 129 patients underwent CD and completed a total of 788 cycles. The desensitization protocol prevented HSRs in 96% (753 out of 788) of these cycles. Patients achieved an average of 6.1 cycles (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 10.5 years 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 (3.5 h) 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.

AB - 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 3.5 h. Results 129 patients underwent CD and completed a total of 788 cycles. The desensitization protocol prevented HSRs in 96% (753 out of 788) of these cycles. Patients achieved an average of 6.1 cycles (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 10.5 years 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 (3.5 h) 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.

KW - Allergy to carboplatin

KW - Carboplatin desensitization

KW - Gynecologic malignancy

KW - Hypersensitivity reactions

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