title: Outpatient rapid 4-step desensitization for gynecologic oncology patients with mild to low-risk, moderate hypersensitivity reactions to carboplatin/cisplatin.
abstract: OBJECTIVE
  The primary objective of this study is to assess the efficacy and safety of an outpatient, 4-step, one-solution desensitization protocol in gynecologic oncology patients with history of mild to low-risk, moderate hypersensitivity reactions (HSRs) to platinums (carboplatin and cisplatin).
  
  
  METHODS
  This was a single institutional retrospective review. Gynecologic oncology patients with a documented history of mild or low-risk, moderate immediate HSRs to carboplatin/cisplatin and continued treatment with 4-step, one-solution desensitization protocols in the outpatient infusion center were included. Patients with delayed HSRs or immediate high-risk, moderate or severe HSRs were excluded. The primary end point was the rate of successful administrations of each course of platinums.
  
  
  RESULTS
  From January 2011 to June 2013, eighteen eligible patients were evaluated for outpatient 4-step, one-solution desensitization. Thirteen patients had a history of HSRs to carboplatin and 5 with HSRs to cisplatin. All of 18 patients successfully completed 94 (98.9%) of 95 desensitization courses in the outpatient infusion center. Eight of 8 (100%) patients with initial mild HSRs completed 29/29 (100%) desensitization courses, and 9 of 10 (90%) of patients with initial moderate HSRs completed 65/66 (94%) desensitization courses. In total, 65/95 (68%) desensitizations resulted in no breakthrough reactions, and mild, moderate and severe breakthrough reactions were seen in 19%, 12% and 1% desensitizations, respectively. No patients were hospitalized during desensitization.
  
  
  CONCLUSIONS
  The outpatient rapid, 4-step, one-solution desensitization protocol was effective and appeared safe among gynecologic oncology patients who experienced mild to low-risk, moderate HSRs to carboplatin/cisplatin.
authors.affiliation: Department of Pharmacy, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43220, USA.
authors.forename: Quan
authors.initials: Q
authors.lastname: Li
authors.affiliation: Division of Gynecology Oncology, Department of Gynecology and Obstetrics, The Ohio State University College of Medicine, Columbus, OH 43220, USA.
authors.forename: David
authors.initials: D
authors.lastname: Cohn
authors.affiliation: College of Pharmacy, The Ohio State University, Columbus, OH 43220, USA.
authors.forename: Allyson
authors.initials: A
authors.lastname: Waller
authors.affiliation: Division of Gynecology Oncology, Department of Gynecology and Obstetrics, The Ohio State University College of Medicine, Columbus, OH 43220, USA.
authors.forename: Floor
authors.initials: F
authors.lastname: Backes
authors.affiliation: Division of Gynecology Oncology, Department of Gynecology and Obstetrics, The Ohio State University College of Medicine, Columbus, OH 43220, USA.
authors.forename: Larry
authors.initials: L
authors.lastname: Copeland
authors.affiliation: Division of Gynecology Oncology, Department of Gynecology and Obstetrics, The Ohio State University College of Medicine, Columbus, OH 43220, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Fowler
authors.affiliation: Division of Gynecology Oncology, Department of Gynecology and Obstetrics, The Ohio State University College of Medicine, Columbus, OH 43220, USA.
authors.forename: Ritu
authors.initials: R
authors.lastname: Salani
authors.affiliation: Division of Gynecology Oncology, Department of Gynecology and Obstetrics, The Ohio State University College of Medicine, Columbus, OH 43220, USA. Electronic address: david.o'malley@osumc.edu.
authors.forename: David
authors.initials: D
authors.lastname: O'Malley
mesh_terms: D000553:Ambulatory Care; D000970:Antineoplastic Agents / Q000009:adverse effects*; D016190:Carboplatin / Q000009:adverse effects*; D002945:Cisplatin / Q000009:adverse effects*; D003888:Desensitization, Immunologic / Q000379:methods*; D004342:Drug Hypersensitivity / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D005833:Genital Neoplasms, Female / Q000188:drug therapy*; D006801:Humans; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin; D002945:Cisplatin
keywords: Carboplatin; Cisplatin; Desensitization; Gynecologic oncology; Hypersensitivity