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

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13 Scopus citations

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

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Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Altwerger, G., Gressel, G. M., English, D. P., Nelson, W. K., Carusillo, N., Silasi, D. A., Azodi, M., Santin, A., Schwartz, P. E., & Ratner, E. S. (2017). Platinum desensitization in patients with carboplatin hypersensitivity: A single-institution retrospective study. Gynecologic Oncology, 144(1), 77-82. https://doi.org/10.1016/j.ygyno.2016.09.027