1. Carboplatin Rechallenge After Hypersensitivity Reactions in Pediatric Patients With Low-Grade Glioma
- Author
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Amish C, Shah, Jane E, Minturn, Yimei, Li, Jean B, Belasco, Peter C, Phillips, Tammy I, Kang, Kristina A, Cole, Angela J, Waanders, Rosanna, Pollack, Concetta, Didomenico, Cynthia, Wildes, and Michael J, Fisher
- Subjects
Male ,Adolescent ,Infant ,Antineoplastic Agents ,Glioma ,Antineoplastic Agents, Phytogenic ,Carboplatin ,Central Nervous System Neoplasms ,Drug Hypersensitivity ,Treatment Outcome ,Histamine H2 Antagonists ,Adrenal Cortex Hormones ,Vincristine ,Child, Preschool ,Histamine H1 Antagonists ,Humans ,Female ,Desensitization, Psychologic ,Neoplasm Grading ,Child ,Algorithms ,Retrospective Studies - Abstract
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.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.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.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.
- Published
- 2015