Carboplatin Rechallenge After Hypersensitivity Reactions in Pediatric Patients With Low-Grade Glioma

Background The high prevalence of carboplatin hypersensitivity reactions (HSR) significantly affects the treatment of pediatric patients with low‐grade glioma (LGG). Rechallenging patients is an option that must balance the risks of repeat allergic reaction to the benefits of retaining an effective...

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Published in:Pediatric blood & cancer 2016-01, Vol.63 (1), p.21-26
Main Authors: Shah, Amish C., Minturn, Jane E., Li, Yimei, Belasco, Jean B., Phillips, Peter C., Kang, Tammy I., Cole, Kristina A., Waanders, Angela J., Pollack, Rosanna, Didomenico, Concetta, Wildes, Cynthia, Fisher, Michael J.
Format: Article
Language:English
Subjects:
Adolescent
Adrenal Cortex Hormones - administration & dosage
Algorithms
allergic reaction
Antineoplastic Agents - administration & dosage
Antineoplastic Agents - adverse effects
Antineoplastic Agents, Phytogenic - administration & dosage
carboplatin
Carboplatin - administration & dosage
Carboplatin - adverse effects
Central Nervous System Neoplasms - drug therapy
Child
Child, Preschool
desensitization
Desensitization, Psychologic
Drug Hypersensitivity - therapy
Female
Glioma - drug therapy
Hematology
Histamine H1 Antagonists - administration & dosage
Histamine H2 Antagonists - administration & dosage
Humans
hypersensitivity
Infant
low-grade glioma
Male
Neoplasm Grading
Oncology
Pediatrics
rechallenge
Retrospective Studies
Treatment Outcome
Vincristine - administration & dosage
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Summary:Background The high prevalence of carboplatin hypersensitivity reactions (HSR) significantly affects the treatment of pediatric patients with low‐grade glioma (LGG). Rechallenging patients is an option that must balance the risks of repeat allergic reaction to the benefits of retaining an effective anti‐tumor regimen. Procedure We performed a retrospective review of children with LGG treated with carboplatin and vincristine between October 2000 and April 2013, who had a documented HSR to carboplatin. Patients were re‐exposed to carboplatin using either precautionary measures (prolonged infusion time and premedication with H1 antagonists, H2 antagonists, and corticosteroids), a desensitization protocol, or both. Results We report the results of our institutional experience of carboplatin re‐exposure using both premedication with a prolonged infusion time and a desensitization protocol. Overall, 40 of 55 (73%) patients were successfully rechallenged with carboplatin, including 19 of 25 (76%) patients who underwent desensitization. Conclusion Our results demonstrate re‐exposure to be a safe alternative to abandoning carboplatin for patients with a hypersensitivity reaction. We propose a clinical algorithm for treatment. Pediatr Blood Cancer 2015; 9999:1–6 © 2015 Wiley Periodicals, Inc.
ISSN:1545-5009
1545-5017
DOI:10.1002/pbc.25697