Hypersensitivity reactions to epipodophyllotoxins in children with acute lymphoblastic leukemia

Incidence, clinical characteristics, and outcome of hypersensitivity reactions to teniposide (VM‐26), etoposide (VP‐16), or both were determined in 108 children with acute lymphoblastic leukemia (ALL) treated with a contemporary regimen of intensive multiagent chemotherapy. Fifty (46%) of the 108 pa...

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Bibliographic Details
Published in:Cancer 1991-02, Vol.67 (4), p.1070-1075
Main Authors: Kellie, Stewart J., Crist, William M., Pui, Ching‐Hon, Crone, Mary E., Fairclough, Diane L., Rodman, John H., Rivera, Gaston K.
Format: Article
Language:English
Subjects:
Adolescent
Adrenal Cortex Hormones - therapeutic use
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Bronchial Spasm - chemically induced
Child
Child, Preschool
Cyanosis - chemically induced
Diphenhydramine - therapeutic use
Dose-Response Relationship, Drug
Drug Hypersensitivity - etiology
Drug Hypersensitivity - prevention & control
Etoposide - administration & dosage
Etoposide - adverse effects
Female
Humans
Hypotension - chemically induced
Infant
Male
Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications
Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy
Premedication
Teniposide - administration & dosage
Teniposide - adverse effects
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Summary:Incidence, clinical characteristics, and outcome of hypersensitivity reactions to teniposide (VM‐26), etoposide (VP‐16), or both were determined in 108 children with acute lymphoblastic leukemia (ALL) treated with a contemporary regimen of intensive multiagent chemotherapy. Fifty (46%) of the 108 patients had one or more hypersensitivity reactions. The risk of any child having an initial reaction over the cumulative dose range studied was 52% (95% confidence limits, 41% and 63%) for VM‐26, compared with 34% (95% confidence limits, 24% and 44%) for VP‐16. The risk of having an initial reaction to VM‐26 or VP‐16 was clearly related to the cumulative dose. This risk peaked at 1500 to 2000 mg/m2 for VM‐26 and at 2000–3000 mg/m2 for VP‐16. All reactions were Type 1 reactions according to the Gell and Coombs classification, characterized by urticaria, angioedema, flushing, rashes, or hypotension, and 86% of reactions were of Grade 1 or 2 severity according to standard criteria. There was no evidence of increasing clinical severity on repeated rechallenge with premedication, and no deaths occurred. The findings suggested that hypersensitivity reactions to epipodophyllotoxins in children with ALL are more common than previously reported, but only rarely constitute dose‐limiting toxicity.
ISSN:0008-543X
1097-0142
DOI:10.1002/1097-0142(19910215)67:4<1070::AID-CNCR2820670434>3.0.CO;2-X