Department of Urology, Clínica Universidad de Navarra, Madrid, Spain.
Department of Urology, University Hospital Ramón y Cajal, Madrid, Spain.
Urol Oncol. 2022 Jul;40(7):345.e19-345.e23. doi: 10.1016/j.urolonc.2022.02.018. Epub 2022 Apr 14.
Mitomycin C (MMC) is one of the most frequently utilized intravesical chemotherapy drugs for the management of non-muscle-invasive bladder cancer (NMIBC). Allergic reactions (Type 4 delayed hypersensitivity) are seldomly reported in the literature but not so infrequent in daily practice, its incidence has been increasing with the use of device-assisted hyperthermia. This study aims to identify the incidence, risk factors, and clinical characteristics of patients with allergic reactions to MMC.
Single-center retrospective cohort from June 2014 to August 2018. Patients with intermediate or high-risk NMIBC were included. Patients received passive MMC (4 weekly and eleven monthly instillations of 40mg of MMC) or Chemohyperthermia (CHT) with MMC (6 weekly and 6-monthly instillations, heated at 43°C [+/- 0.5°C] using Combat BRS).
We included 258 patients (MMC = 157, CHT = 101) and found 7 (4.4%) suspected and 4 confirmed (2.4%) allergies in the passive MMC group and 11 suspected (10.9%) and 7 confirmed (6.9%) in the CHT group. The mean number of instillations received before developing the allergy was 6 in the passive MMC and 5 in the CHT group. Seven out of 18 suspected allergy cases were pseudo-allergic reactions with negative allergy tests. Early postoperative MMC instillation was associated with an increased risk of allergy (OR 2.47 [CI 1.39-4.36], P = 0.001), while neither history of atopy nor history of other medications allergy was found to increase the risk.
MMC allergy risk is increased with the use of device-assisted hyperthermia with an incidence of 2.4% for passive MMC and 6.9% for CHT. History of prior allergies does not seem to increase the risk of developing MMC allergy. In this series 38% of suspected cases were found to be pseudo-allergic reactions, highlighting the need to confirm the diagnosis before definitively stopping the treatment.
丝裂霉素 C（MMC）是用于治疗非肌肉浸润性膀胱癌（NMIBC）的最常用的膀胱内化疗药物之一。过敏反应（IV 型迟发型超敏反应）在文献中很少报道，但在日常实践中并不少见，其发生率随着设备辅助热疗的使用而增加。本研究旨在确定对 MMC 过敏反应的发生率、危险因素和临床特征。
2014 年 6 月至 2018 年 8 月的单中心回顾性队列研究。纳入中高危 NMIBC 患者。患者接受被动 MMC（4 周和 11 个月各 40mg 1 次）或 MMC 热化疗（CHT）（6 周和 6 个月各 1 次，在 43°C[+/-0.5°C]下加热使用 Combat BRS）。
我们纳入了 258 名患者（MMC=157，CHT=101），在被动 MMC 组中发现了 7 例（4.4%）疑似过敏和 4 例（2.4%）确诊过敏，在 CHT 组中发现了 11 例（10.9%）疑似过敏和 7 例（6.9%）确诊过敏。在出现过敏反应之前，接受的平均灌注次数在被动 MMC 组为 6 次，在 CHT 组为 5 次。18 例疑似过敏反应中，有 7 例为假性过敏反应，过敏试验阴性。术后早期 MMC 灌注与过敏风险增加相关（OR 2.47[CI 1.39-4.36]，P=0.001），而特应性疾病史或其他药物过敏史均未发现增加过敏风险。
设备辅助热疗中 MMC 过敏风险增加，被动 MMC 的发生率为 2.4%，CHT 的发生率为 6.9%。既往过敏史似乎不会增加发生 MMC 过敏的风险。在本系列中，38%的疑似病例被发现为假性过敏反应，这突出表明在明确停止治疗之前需要确认诊断。
