Platinum desensitization in patients with carboplatin hypersensitivity: A single-institution retrospective study

abstract

Highlights

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Highlights an effective, safe and short desensitization protocol

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Allows hypersensitive patients to continue with carboplatin therapy

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Employs a straightforward home and inpatient premedication regimen

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Identifies factors that help to risk stratify patients undergoing desensitization

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Decreases the burden on health care by reducing admissions to the hospital and ICU

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Objectives

The carboplatin desensitization (CD) protocol presented here allows patients with either a positive skin test or a prior hypersensitivity reaction (HSR) to safely, rapidly and effectively continue with carboplatin infusions. Newly described factors can identify patients at risk for developing adverse events during CD.

Methods

A retrospective review was performed on patients with gynecologic cancer who underwent CD between 2005 and 2014. The CD protocol uses a four-step dilution process over 3.5 h.

Results

129 patients underwent CD and completed a total of 788 cycles. The desensitization protocol prevented HSRs in 96% (753 out of 788) of these cycles. Patients achieved an average of 6.1 cycles (SD ± 4.55, range 0–23) with CD. The CD protocol allowed 73% (94 of 129) of the patients to undergo carboplatin infusion without reaction. Patients with moderate to life-threatening HSRs (grade 2 through 4) were 10.5 years younger at initial CD than patients with grades 0 or 1 HSRs (52.3 vs. 63, P = 0.0307). One patient death occurred during her thirteenth desensitization cycle. The HSR in this case was complicated by pre-exisiting pulmonary hypertension.

Conclusions

This is the largest study of its kind showing a safe, effective and rapid (3.5 h) CD protocol. The majority of patients with a history of either carboplatin hypersensitivity reaction or a positive skin test completed the CD protocol without HSRs. Age was identified as a risk factor for HSR severity during CD. Age can be employed along with pre-load dependent cardiac conditions as a way to help risk stratify patients undergoing CD.