Abstract
Background: Carboplatin based regimens have demonstrated activity in pediatric patients with low grade gliomas (LGG). However, carboplatin hypersensitivity reactions (CHRs) may be a major problem leading to premature cessation of an effective therapy. The objectives of this study were to describe the prevalence, characteristics and management of CHR.Methods: We performed a retrospective review of children with LGG treated between January 1994 and July 2015 with carboplatin and vincristine who had a documented CHR. We identified two groups: the first was treated following the schema proposed by Packer et al., and re-exposed to carboplatin using a desensitization protocol; the second was treated according to protocol SIOP LGG 2004 and re-exposed with the infusion time prolonged.Results: CHRs were observed in 16 patients (34%) out of 47. Hypersensitivity reactions occurred in 6 patients (20.7%) of the first, and 10 patients (55.5%) of the second group, respectively. The grade 2 reactions were the most common. The median number of carboplatin doses administered at the first episode of CHR was 7 (range, 3–9) for the first group, and 8.5 (range, 5–11) for the second, respectively. Six patients were re-exposed to carboplatin using a desensitization protocol; 10 with a prolonged infusion time. Overall success rate for re-exposition was 43.75% (100% and 10%, respectively) (P = 0.001).Conclusions: Our results show that re-exposure is a safe alternative to abandoning carboplatin. Desensitization showed greater effectiveness compared to a prolonged infusion time, which allowed the patients to receive effective treatment without adverse reactions.
Highlights
Low-grade glial tumors are the most common brain tumors of childhood (Packer et al, 2008)
The aim of this study is to summarize the incidence and the clinical features of carboplatin hypersensitivity reaction (CHR) occurring in children with low-grade gliomas (LGG) treated with carboplatin and vincristine and their impact on treatment efficacy, in order to outline possible adequate prevention and management strategies
Sixteen (34%) children were identified as having a CHR; 6 (20.7%) occurred in the group treated according to Packer et al, and 10 (55.5%) occurred in the group treated according to protocol SIOP LGG 2004
Summary
Low-grade glial tumors are the most common brain tumors of childhood (Packer et al, 2008). Carboplatin, usually given with vincristine, is one of the front-line treatments for Effectiveness of Desensitization pediatric low-grade gliomas (LGG) (Packer et al, 1993). The combination is associated with a 5-year event-free survival of 39% in sporadic, and 69% in neurofibromatosis type 1 (NF1)associated LGG (Ater et al, 2016) Other combination regimens, such as thioguanine, procarbazine, lomustine, and vincristine, cisplatin/etoposide, bevacizumab/irinotecan and temozolomide have produced consistent, durable responses (Packer et al, 1997; Massimino et al, 2010) but each of these therapies has drawbacks which include late toxicities such as second malignant neoplasms, infertility, vasculopathy/stroke or toxicity due to concomitant therapies (Ruggiero et al, 2010) as well as concerns that the efficacy of these other options is no better than the first line regimen (Bowers et al, 2006; Eichenauer et al, 2014). One of the most common side effects leading to premature treatment cessation is carboplatin hypersensitivity reaction (CHR). The objectives of this study were to describe the prevalence, characteristics and management of CHR
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