Carboplatin Hypersensitivity Reactions in Pediatric Low Grade Glioma Are Protocol Specific and Desensitization Shows Poor Efficacy

Dodgshun, Andrew; Hansford, Jordan R.; Cole, Theresa; Choo, Sharon; Sullivan, Michael J.

doi:10.1002/pbc.25686

Cited by 19 publications

(26 citation statements)

References 31 publications

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“…This difference could be due to the different patterns of desensitization used. The main variables influencing the success of re-exposure appear to be: the starting dose, the infusion rate and the number of increments (Lafay-Cousin et al, 2005; Ruggiero et al, 2013a; Dodgshun et al, 2016; Shah et al, 2016). A lower starting dose, a slow infusion, and a number of increments greater than or equal to 4, are associated with a greater probability of success.…”

Section: Discussionmentioning

confidence: 99%

Rechallenge to Carboplatin in Children with Low Grade Glioma and Carboplatin Hypersensitivity Reactions

et al. 2017

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Background: Carboplatin based regimens have demonstrated activity in pediatric patients with low grade gliomas (LGG). However, carboplatin hypersensitivity reactions (CHRs) may be a major problem leading to premature cessation of an effective therapy. The objectives of this study were to describe the prevalence, characteristics and management of CHR.Methods: We performed a retrospective review of children with LGG treated between January 1994 and July 2015 with carboplatin and vincristine who had a documented CHR. We identified two groups: the first was treated following the schema proposed by Packer et al., and re-exposed to carboplatin using a desensitization protocol; the second was treated according to protocol SIOP LGG 2004 and re-exposed with the infusion time prolonged.Results: CHRs were observed in 16 patients (34%) out of 47. Hypersensitivity reactions occurred in 6 patients (20.7%) of the first, and 10 patients (55.5%) of the second group, respectively. The grade 2 reactions were the most common. The median number of carboplatin doses administered at the first episode of CHR was 7 (range, 3–9) for the first group, and 8.5 (range, 5–11) for the second, respectively. Six patients were re-exposed to carboplatin using a desensitization protocol; 10 with a prolonged infusion time. Overall success rate for re-exposition was 43.75% (100% and 10%, respectively) (P = 0.001).Conclusions: Our results show that re-exposure is a safe alternative to abandoning carboplatin. Desensitization showed greater effectiveness compared to a prolonged infusion time, which allowed the patients to receive effective treatment without adverse reactions.

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Section: Discussionmentioning

confidence: 99%

Rechallenge to Carboplatin in Children with Low Grade Glioma and Carboplatin Hypersensitivity Reactions

et al. 2017

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“…Carboplatin HSR has been described mostly in pediatric series of LGG, where the reported incidence is up to 47% depending on the schedules of administration (Lafay-Cousin et al, 2008; Dodgshun et al, 2016). …”

Section: Incidencementioning

confidence: 99%

“…Genc et al (2012) observed a frequency of 40% in their study. Recently, carboplatin hypersensitivity was documented in 47% of patients by Dodgshun et al (2016), and in the study by Shah et al (2016) of 144 children with LGG treated with carboplatin and vincristine, 56 (39%) experienced an HSR to carboplatin.…”

Section: Incidencementioning

confidence: 99%

Hypersensitivity to Carboplatin in Children with Malignancy

et al. 2017

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Purpose: Carboplatin-based regimens have proven efficacy in children with cancer. However, the development of hypersensitivity reactions (HSRs) may have a negative impact on treatment intensity and patients’ outcome. The aim of this review is to summarize the incidence and the clinical features of HSRs occurring in children with cancer treated with carboplatin and their impact on treatment efficacy.Methods: Data were collected by searching for relevant studies on the incidence, clinical features and management of possible side effects about the use of carboplatin in children, published from March 1987 to October 2016 in the PubMed database.Results: Carboplatin HSRs present with mild/moderate to severe clinical patterns. The risk of HSR is related to the cumulative number of infusions. Moreover, a greater risk of developing an HSR has been observed in younger patients than in older age groups of children; risk is also greater in girls and in patients with a prior history of allergy to other drugs. Management options include cessation of carboplatin and switching to another agent, premedication with antihistamines and/or corticosteroids, and carboplatin desensitization. For sensitized patients who have obtained benefits from carboplatin, the continuation of the treatment is desirable and desensitization protocols have showed promising results.Conclusion: Clinicians must not underestimate the potential risk and occurrence of carboplatin HSRs in the pediatric population in order to outline adequate management strategies. Desensitization protocols should be considered for patients sensitive to carboplatin in order to avoid having to discontinue an effective chemotherapy.

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“…4 leading to treatment withdrawal and the use of second-line drugs. Additionally, carboplatin administered in association with vincristine has been found to be a risk factor for adverse events, 5 raising the incidence to 68% of children treated. In response, carboplatin desensitization has been used with great success as an alternative to treatment withdrawal in adults, 3,6 allowing the patient to benefit from this drug.…”

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confidence: 99%

“…The evidence in children is far more limited, however, and in some cases, poorer efficacy has been reported. 5 In this manuscript, we describe the initial experience with carboplatin allergy and desensitization in a paediatric tertiary hospital in Madrid, 8 and all patients underwent skin prick (SPT) (10 mg/mL) and intradermal testing (ID) (1 and 10 mg/mL) for hypersensitivity to carboplatin as previously described. In the 2.5-year period reported, 6 of 7 (85.7%) patients receiving carboplatin had a reaction compatible with carboplatin hypersensitivity, 5 of whom were referred to the allergy department for carboplatin desensitization.…”

mentioning

confidence: 99%

Initial experience with carboplatin desensitization: A case series in a paediatric hospital

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et al. 2017

Pediatric Allergy Immunology

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Carboplatin Hypersensitivity Reactions in Pediatric Low Grade Glioma Are Protocol Specific and Desensitization Shows Poor Efficacy

Abstract: Hypersensitivity reactions to carboplatin are more common in this cohort than previously reported and rates are protocol-dependent. Desensitization showed limited effectiveness in this cohort.

Cited by 19 publications

References 31 publications

Rechallenge to Carboplatin in Children with Low Grade Glioma and Carboplatin Hypersensitivity Reactions

Rechallenge to Carboplatin in Children with Low Grade Glioma and Carboplatin Hypersensitivity Reactions

Hypersensitivity to Carboplatin in Children with Malignancy

Initial experience with carboplatin desensitization: A case series in a paediatric hospital

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