title: Platinum desensitization in patients with carboplatin hypersensitivity: A single-institution retrospective study.
abstract: OBJECTIVE
  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 3.5h.
  
  
  RESULTS
  129 patients underwent CD and completed a total of 788cycles. The desensitization protocol prevented HSRs in 96% (753 out of 788) of these cycles. Patients achieved an average of 6.1cycles (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 10.5years 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 (3.5h) 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.
authors: Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA. Electronic address: gary.altwerger@yale.edu.
authors: Gary
authors: G
authors: Altwerger
authors: Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA.
authors: Gregory M
authors: GM
authors: Gressel
authors: Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA.
authors: Diana P
authors: DP
authors: English
authors: Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA.
authors: Wendelin K
authors: WK
authors: Nelson
authors: Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA.
authors: Nina
authors: N
authors: Carusillo
authors: Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA.
authors: Dan-Arin
authors: DA
authors: Silasi
authors: Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA.
authors: Masoud
authors: M
authors: Azodi
authors: Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA.
authors: Alessandro
authors: A
authors: Santin
authors: Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA.
authors: Peter E
authors: PE
authors: Schwartz
authors: Yale University, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, P.O. Box 208063, New Haven, CT 06511, USA.
authors: Elena S
authors: ES
authors: Ratner
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016190:Carboplatin / Q000009:adverse effects* / Q000276:immunology* / Q000627:therapeutic use; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D004342:Drug Hypersensitivity / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005833:Genital Neoplasms, Female / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D010984:Platinum / Q000276:immunology*; D012189:Retrospective Studies; D012882:Skin Tests
chemical_list: D010984:Platinum; D016190:Carboplatin
keywords: Allergy to carboplatin; Carboplatin desensitization; Gynecologic malignancy; Hypersensitivity reactions