Desensitization To Cytostatic Drugs
Saturday, March 3, 2018
South Hall A2 (Convention Center)
Irene Garcia Gutierrez, MD, Maria L. Baeza, MD PhD, Alicia Prieto, MD PhD, Pilar Tornero, MD
RATIONALE: The aim was to evaluate the security of a 12 to 16-step desensitization protocol with cytostatic drugs and to determine the risk factors that predict breakthrough reactions.

METHODS: 702 desensitizations (508 platins, 141 taxanes, 25 irinotecan, 4 bleomycin, 5 pemetrexed, 5 cyclophosphamide, 11 doxorubicin, 3 etoposide) in 149 patients (mean age 58.7, SD=12.9 years; 66% female) were analyzed from October 2012 to June 2017. The initial reaction was elicited by platins (66%), taxanes (27%) and others (7%), and 94% were immediate reactions (33% mild, 42% moderate, 25% severe). Patients underwent a 12-step protocol, but those with severe symptoms (16-step protocol), after premedication (dexclorpheniramine, dexamethasone, ASA and montelukast.)

RESULTS: 36% of patients suffered a breakthrough reaction (20% of desensitizations). 23% recurred at least once during the same infusion. 84% were mild (94.1%, 79.7%, and 76.5% in patients with an initial mild, moderate or severe reaction, respectively). 10% were moderate and 6% were severe. 4.4% received epinephrine. Only 1.3% of desensitizations were stopped and could not be completed. 72% of the protocols could be shortened in 1 hour by increasing the final flow rate in following cycles. No fatal reaction occurred. The reactions were more frequent, but no more severe, in patients with atopy (29.3% vs. 19%, p= 0.023) and with platins vs taxanes (24% vs 10% p=0.0003).

CONCLUSIONS: This 12 to 16-step desensitization protocol for cytostatic drugs is safe. Most of the protocols could be shortened during the following cycles. Atopy and reactions to platins were risk factors to suffer a reaction during desensitization.