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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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| Published in: | Cancer 1991-02, Vol.67 (4), p.1070-1075 |
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| Main Authors: | , , , , , , |
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| Language: | English |
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| container_end_page | 1075 |
| container_issue | 4 |
| container_start_page | 1070 |
| container_title | Cancer |
| container_volume | 67 |
| creator | Kellie, Stewart J. Crist, William M. Pui, Ching‐Hon Crone, Mary E. Fairclough, Diane L. Rodman, John H. Rivera, Gaston K. |
| description | 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. |
| doi_str_mv | 10.1002/1097-0142(19910215)67:4<1070::AID-CNCR2820670434>3.0.CO;2-X |
| format | article |
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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.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/1097-0142(19910215)67:4<1070::AID-CNCR2820670434>3.0.CO;2-X</identifier><identifier>PMID: 1991254</identifier><language>eng</language><publisher>New York: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>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</subject><ispartof>Cancer, 1991-02, Vol.67 (4), p.1070-1075</ispartof><rights>Copyright © 1991 American Cancer Society</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c5004-2c27d065feb65b51d6ed0661ac8b8c6c3a9f22062279bf009dfd1264ac3b0b2a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/1991254$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kellie, Stewart J.</creatorcontrib><creatorcontrib>Crist, William M.</creatorcontrib><creatorcontrib>Pui, Ching‐Hon</creatorcontrib><creatorcontrib>Crone, Mary E.</creatorcontrib><creatorcontrib>Fairclough, Diane L.</creatorcontrib><creatorcontrib>Rodman, John H.</creatorcontrib><creatorcontrib>Rivera, Gaston K.</creatorcontrib><title>Hypersensitivity reactions to epipodophyllotoxins in children with acute lymphoblastic leukemia</title><title>Cancer</title><addtitle>Cancer</addtitle><description>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.</description><subject>Adolescent</subject><subject>Adrenal Cortex Hormones - therapeutic use</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Bronchial Spasm - chemically induced</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cyanosis - chemically induced</subject><subject>Diphenhydramine - therapeutic use</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug Hypersensitivity - etiology</subject><subject>Drug Hypersensitivity - prevention & control</subject><subject>Etoposide - administration & dosage</subject><subject>Etoposide - adverse effects</subject><subject>Female</subject><subject>Humans</subject><subject>Hypotension - chemically induced</subject><subject>Infant</subject><subject>Male</subject><subject>Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications</subject><subject>Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy</subject><subject>Premedication</subject><subject>Teniposide - administration & dosage</subject><subject>Teniposide - adverse effects</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1991</creationdate><recordtype>article</recordtype><recordid>eNqVkE2L1EAQhhtR1tnVnyDkJHrIWP2RzmRchCV-7MLigCgMeCg6nQ7T2knHdMfd_HsTZlX0IHgqqt6qt6oeQkoKawrAXlAo8hSoYM9oUVBgNHsu8604p5DDdntx9Tot35cf2IaBzEFw8YqvYV3uXrJ0f4-sfk3fJysA2KSZ4PuH5DSEL3Oas4yfkJPFmGViRfBy6s0QTBdstN9tnJLBKB2t70ISfWJ62_va94fJOR_9rZ3Ltkv0wbp6MF1yY-MhUXqMJnFT2x985VSIVifOjF9Na9Uj8qBRLpjHd_GMfHr75mN5mV7v3l2VF9epzgBEyjTLa5BZYyqZVRmtpZlTSZXeVBstNVdFw-Z_GcuLqgEo6qamTAqleQUVU_yMPD369oP_NpoQsbVBG-dUZ_wYkEoqoSjE3Pj52KgHH8JgGuwH26phQgq44McFIC4A8Sd-lDkKXPAjzvjxT_zIEbDcIcP97P7k7oyxak392_vIe9abo35jnZn-b_U_N_-l8B-G-6U9</recordid><startdate>19910215</startdate><enddate>19910215</enddate><creator>Kellie, Stewart J.</creator><creator>Crist, William M.</creator><creator>Pui, Ching‐Hon</creator><creator>Crone, Mary E.</creator><creator>Fairclough, Diane L.</creator><creator>Rodman, John H.</creator><creator>Rivera, Gaston K.</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope></search><sort><creationdate>19910215</creationdate><title>Hypersensitivity reactions to epipodophyllotoxins in children with acute lymphoblastic leukemia</title><author>Kellie, Stewart J. ; Crist, William M. ; Pui, Ching‐Hon ; Crone, Mary E. ; Fairclough, Diane L. ; Rodman, John H. ; Rivera, Gaston K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5004-2c27d065feb65b51d6ed0661ac8b8c6c3a9f22062279bf009dfd1264ac3b0b2a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1991</creationdate><topic>Adolescent</topic><topic>Adrenal Cortex Hormones - therapeutic use</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Bronchial Spasm - chemically induced</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cyanosis - chemically induced</topic><topic>Diphenhydramine - therapeutic use</topic><topic>Dose-Response Relationship, Drug</topic><topic>Drug Hypersensitivity - etiology</topic><topic>Drug Hypersensitivity - prevention & control</topic><topic>Etoposide - administration & dosage</topic><topic>Etoposide - adverse effects</topic><topic>Female</topic><topic>Humans</topic><topic>Hypotension - chemically induced</topic><topic>Infant</topic><topic>Male</topic><topic>Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications</topic><topic>Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy</topic><topic>Premedication</topic><topic>Teniposide - administration & dosage</topic><topic>Teniposide - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kellie, Stewart J.</creatorcontrib><creatorcontrib>Crist, William M.</creatorcontrib><creatorcontrib>Pui, Ching‐Hon</creatorcontrib><creatorcontrib>Crone, Mary E.</creatorcontrib><creatorcontrib>Fairclough, Diane L.</creatorcontrib><creatorcontrib>Rodman, John H.</creatorcontrib><creatorcontrib>Rivera, Gaston K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kellie, Stewart J.</au><au>Crist, William M.</au><au>Pui, Ching‐Hon</au><au>Crone, Mary E.</au><au>Fairclough, Diane L.</au><au>Rodman, John H.</au><au>Rivera, Gaston K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hypersensitivity reactions to epipodophyllotoxins in children with acute lymphoblastic leukemia</atitle><jtitle>Cancer</jtitle><addtitle>Cancer</addtitle><date>1991-02-15</date><risdate>1991</risdate><volume>67</volume><issue>4</issue><spage>1070</spage><epage>1075</epage><pages>1070-1075</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><notes>ObjectType-Article-2</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-1</notes><notes>content type line 23</notes><abstract>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.</abstract><cop>New York</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>1991254</pmid><doi>10.1002/1097-0142(19910215)67:4<1070::AID-CNCR2820670434>3.0.CO;2-X</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0008-543X |
| ispartof | Cancer, 1991-02, Vol.67 (4), p.1070-1075 |
| issn | 0008-543X 1097-0142 |
| language | eng |
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| source | EZB Electronic Journals Library |
| 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 |
| title | Hypersensitivity reactions to epipodophyllotoxins in children with acute lymphoblastic leukemia |
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