Carboplatin hypersensitivity in children. A report of five patients with brain tumors

Abstract

Background. Carboplatin, which is used in the treatment of several childhood tumors, increasingly has been reported to cause hypersensitivity reactions, the majority reported in adults. Five cases of children with primary brain tumors who were treated with carboplatin and developed acute allergic reactions are presented. Methods. The clinical history of each patient is described, as is the schedule, cumulative dose, and number of infusions of carboplatin, type of reaction, and retreatment. Results. Four of the five patients had histologically proven low grade astrocytic tumors; three had juvenile pilocytic astrocytomas, and one had a mixed oligoastrocytoma. One patient with neurofibromatosis type I had radiographically‐defined bilateral optic nerve gliomas. Three patients had prior chemotherapy, one with cisplatin. All five patients developed hypersensitivity reactions such as urticaria, facial erythema, and facial swelling after multiple infusions of carboplatin. Two were retreated with carboplatin after receiving antihistamines, but still developed a reaction. Carboplatin therapy was discontinued in all patients. Conclusion. The purpose of this report is to heighten awareness of this potentially serious complication of carboplatin in children so that potentially dangerous retreatment is avoided. As use of a weekly schedule of carboplatin in children with low grade gliomas increases, with planned therapy extending for more than 50 weeks, more hypersensitivity reactions are anticipated. Cancer 1995;75:1171–5.

Life-threatening carboplatin hypersensitivity during conditioning for autologous PBSC transplantation: successful rechallenge after desensitization

“…No hypersensitivity reactions, however, were described in several studies which employed high-dose carboplatin with autologous bone marrow support. 5 This contrast might be a result of the single, large exposure to the drug, rather than the repeated infusions used in the other studies.…”

“…Symptoms have included respiratory (wheezing, dyspnea), gastrointestinal (abdominal cramps, diarrhea), and dermatologic symptoms (pruritus, urticaria, facial erythema, and swelling). 5 Severity of reactions ranged from transient and mild reactions resembling common side-effects of anti-cancer chemotherapy or nearfatal anaphylaxis. 1,5 However, massive pulmonary infiltrations with hemoptysis and hypoxia resulting in transient myocardial ischemia as seen in this case have not been reported to date.…”

“…5 Severity of reactions ranged from transient and mild reactions resembling common side-effects of anti-cancer chemotherapy or nearfatal anaphylaxis. 1,5 However, massive pulmonary infiltrations with hemoptysis and hypoxia resulting in transient myocardial ischemia as seen in this case have not been reported to date. Most cases of hypersensitivity to carboplatin have occurred in patients receiving repeated cycles of carboplatin, denoting the slow development of hypersensitivity in general.…”

“…1,2 Chang et al 5 reported the evolution of hypersensitivity reactions after 12 weekly infusions of carboplatin on average. No hypersensitivity reactions, however, were described in several studies which employed high-dose carboplatin with autologous bone marrow support.…”

“…The first morning dose of etoposide was administered uneventfully. Carboplatin was dissolved in 500 ml of D 5 . saline solution.…”