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

Amish C. Shah; Jane E. Minturn; Yimei Li; Jean B. Belasco; Peter C. Phillips; Tammy I. Kang; Kristina A. Cole; Angela Jae Waanders; Rosanna Pollack; Concetta Didomenico; Cynthia Wildes; Michael J. Fisher

doi:10.1002/pbc.25697

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

Amish C. Shah^*, Jane E. Minturn, Yimei Li, Jean B. Belasco, Peter C. Phillips, Tammy I. Kang, Kristina A. Cole, Angela Jae Waanders, Rosanna Pollack, Concetta Didomenico, Cynthia Wildes, Michael J. Fisher

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

16 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	21-26
Number of pages	6
Journal	Pediatric Blood and Cancer
Volume	63
Issue number	1
DOIs	https://doi.org/10.1002/pbc.25697
State	Published - Jan 1 2016

Keywords

Allergic reaction
Carboplatin
Desensitization
Hypersensitivity
Low-grade glioma
Rechallenge

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Hematology
Oncology

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title = "Carboplatin Rechallenge After Hypersensitivity Reactions in Pediatric Patients With Low-Grade Glioma",

abstract = "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.",

keywords = "Allergic reaction, Carboplatin, Desensitization, Hypersensitivity, Low-grade glioma, Rechallenge",

author = "Shah, {Amish C.} and Minturn, {Jane E.} and Yimei Li and Belasco, {Jean B.} and Phillips, {Peter C.} and Kang, {Tammy I.} and Cole, {Kristina A.} and Waanders, {Angela Jae} and Rosanna Pollack and Concetta Didomenico and Cynthia Wildes and Fisher, {Michael J.}",

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AU - Minturn, Jane E.

AU - Li, Yimei

AU - Belasco, Jean B.

AU - Phillips, Peter C.

AU - Kang, Tammy I.

AU - Cole, Kristina A.

AU - Waanders, Angela Jae

AU - Pollack, Rosanna

AU - Didomenico, Concetta

AU - Wildes, Cynthia

AU - Fisher, Michael J.

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N2 - 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.

AB - 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.

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

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