Lafay-Cousin Lucie, Sung Lillian, Carret Anne-Sophie, Hukin Juliette, Wilson Beverly, Johnston Donna L, Zelcer Shayna, Silva Mariana, Odame Isaac, Mpofu Chris, Strother Douglas, Bouffet Eric
Pediatric Brain Tumor Program, Hospital for Sick Children, Toronto, Ontario, Canada.
Cancer. 2008 Feb 15;112(4):892-9. doi: 10.1002/cncr.23249.
Carboplatin-based regimens have demonstrated activity in pediatric patients with low-grade glioma (LGG). However, carboplatin hypersensitivity reaction (Cb HSR) represents a common and limiting factor for the continuation of therapy.
The objectives of this study were to describe the prevalence, characteristics, and management of Cb HSR and to detail their impact on outcome. The authors conducted a comprehensive, national, retrospective review of children who were diagnosed with LGG between 1985 and 2004 and received treatment with carboplatin.
One hundred five patients from 10 Canadian centers were included. The median patient age at diagnosis was 3.5 years (range, 0.3-16.8 years), and 33 patients (31.4%) had neurofibromatosis type 1. Carboplatin was administered monthly in 46 children and weekly in 59 children. Forty-four patients (41.9%) developed Cb HSR after a median of 10.5 infusions (range, 3-39 infusions). Cb HSR occurred significantly earlier among children on the weekly schedule (4.4 months vs 9.1 months; P = .02). The first allergic reaction was grade I or II in 36 patients (82%). The cumulative incidence of Cb HSR increased with the number of infusions, and there was no evidence of a plateau. The only predictive factor was being a girl rather than a boy (P = .02). Thirty-four of 44 patients with Cb HSR were re-exposed to carboplatin, and 24 of 34 patients (70.5%) had recurrent Cb HSR. A desensitization approach did not provide any advantage compared with premedication alone for altering Cb HSR. The median number of additional Cb infusions delivered was 4 (range, 0.5-34 infusions). The effect of Cb HSR on the 5-year progression-free survival rate was not statistically significant (P = .1).
Forty-two percent of children with LGG who received carboplatin regimens experienced Cb HSR. Most rechallenged children had recurrent Cb HSR despite Cb HSR-altering regimens. Cb HSR did not have an impact on progression-free survival.
基于卡铂的治疗方案已在低级别胶质瘤（LGG）患儿中显示出活性。然而，卡铂过敏反应（Cb HSR）是继续治疗的常见限制因素。
本研究的目的是描述Cb HSR的发生率、特征和管理，并详细说明其对预后的影响。作者对1985年至2004年间被诊断为LGG并接受卡铂治疗的儿童进行了一项全面的全国性回顾性研究。
纳入了来自加拿大10个中心的105例患者。诊断时的中位年龄为3.5岁（范围0.3 - 16.8岁），33例患者（31.4%）患有1型神经纤维瘤病。46例儿童每月给予卡铂，59例儿童每周给予卡铂。44例患者（41.9%）在中位10.5次输注（范围3 - 39次输注）后发生Cb HSR。每周给药方案的儿童中Cb HSR出现明显更早（4.4个月对9.1个月；P = 0.02）。36例患者（82%）的首次过敏反应为I级或II级。Cb HSR累积发生率随输注次数增加，且无平台期证据。唯一的预测因素是女性而非男性（P = 0.02）。44例发生Cb HSR的患者中有34例再次接触卡铂，34例患者中有24例（70.5%）复发Cb HSR。与单纯预处理相比，脱敏方法在改变Cb HSR方面没有任何优势。额外给予卡铂输注的中位次数为4次（范围0.5 - 34次输注）。Cb HSR对5年无进展生存率的影响无统计学意义（P = 0.1）。
接受卡铂治疗方案的LGG患儿中有42%发生Cb HSR。尽管采用了改变Cb HSR的方案，但大多数再次挑战的儿童仍复发Cb HSR。Cb HSR对无进展生存无影响。
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