Thursday, 15 October 2015: 12:00 - 12:15
Room R2 ABC (Floor 3) (Coex Convention Center)
Ju-Young Kim, MD
,
Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
Byung-Keun Kim, MD
,
Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
Woo-Jung Song, MD
,
Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
Hye-Ryun Kang, MD, PhD
,
Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
Heung Woo Park, MD, PhD
,
Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
Sang-Heon Cho, MD, PhD
,
Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
Kyung-up Min, MD, PhD
,
Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
BACKGROUND: Desensitization is a useful method for safely reintroducing oxaliplatin in patients with previous oxaliplatin-hypersensitivity reactions (HSRs). However, breakthrough reactions (BTRs) can occur during desensitization and can be problematic, limiting the application of further courses. We sought to investigate the characteristics and related factors of BTRs during oxaliplatin desensitization.
METHODS: All cases of oxaliplatin desensitization performed at the Seoul National University Hospital from June 2011 through January 2015 were included in this retrospective study. Hypersensitivity reactions were assessed using Common Toxicity Criteria for Adverse Events (CTCAE) ver 4.0.
RESULTS: We performed 203 courses of desensitization in 55 patients with oxaliplatin hypersensitivity. The initial HSRs had developed after 5.2 ± 3.8 cycles (mean ± SD) at a grade of 2.93 ± 0.86. Desensitization was successful in 203 of the 206 cases (98.5%). BTRs occurred in 86 of 203 (42.4%) courses at a grade of 2.00 ± 0.82, which is a significantly lower grade compared to the initial HSR. They appeared predominantly (82.6%) in the last 3 steps of the protocol at an infusion rate of 38.01 ± 25.07 mg/hr. The occurrence of BTRs showed gradual decline by succession of each desensitization course. BTRs were more frequent in patients with previous remote oxaliplatin exposure (56.3% vs. 21.7%, p=0.014), but was not related to patient demographics, CBC, initial infusion rate, oxaliplatin dose, previous HSR grade, or steroid premedication.
CONCLUSIONS: Patients with prior remote exposure to oxaliplatin have an increased risk of BTRs during desensitization. Initial HSR grade had no association to BTR, suggesting that desensitization can be considered regardless of the severity of the initial hypersensitivity reaction. Adjustments in desensitization protocols should be made to prevent BTRs in patients with a history of previous exposure to oxaliplatin.
