Liang Lin, Oh Hyun Kyung, Lee Jae-Hyun, Park Jung-Won, Park Kyung Hee
Graduate School of Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea.
Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Ann Allergy Asthma Immunol. 2025 Aug;135(2):218-225.e2. doi: 10.1016/j.anai.2025.05.010. Epub 2025 May 23.
Hypersensitivity reactions (HSRs) to chemotherapy and monoclonal antibodies may necessitate discontinuation of the initial treatment. Rapid drug desensitization (RDD) is a proven, safe, and effective alternative strategy. However, a few patients still experience breakthrough reactions (BTRs) during RDD.
To evaluate the clinical outcomes of RDD and identify risk factors for BTRs.
We performed a retrospective analysis of patients with cancer treated at Severance Hospital from May 2014 to October 2023. All patients experienced immediate HSRs to chemotherapy or monoclonal antibodies and underwent either a 2‑bag (for grade 1 reactions) or a 4‑bag (for grade 2 to 3 reactions), 11‑step RDD protocol.
A total of 1010 RDD procedures were performed on 213 patients (157 platinum-based drugs, 31 taxanes, 16 monoclonal antibodies, and 9 other drugs). Among them, 259 procedures used a 2-bag protocol and 751 used a 4-bag protocol. BTRs occurred in 207 procedures (20.4%), involving 113 patients (53%). Most BTRs (n = 91) were associated with platinum-based agents, resulting in discontinuation in 15 cases. Logistic regression revealed that severe initial HSRs (odds ratio = 2.101, 95% CI = 1.348-3.276, P = .001) and higher exposure frequency to chemotherapeutic agents (odds ratio = 1.075, 95% CI = 1.010-1.144, P = .023) significantly increased the risk of moderate-to-severe BTRs. Overall, 95.8% of patients completed 1 or more therapy cycles.
This 11-step RDD protocol is safe and effective in a diverse population with cancer. It also demonstrated a direct association between more severe initial HSRs, previous high exposure to chemotherapeutic agents, and the occurrence of BTRs.
化疗和单克隆抗体引起的超敏反应（HSR）可能需要停止初始治疗。快速药物脱敏（RDD）是一种经过验证的安全有效的替代策略。然而，仍有少数患者在RDD期间出现突破性反应（BTR）。
评估RDD的临床结果并确定BTR的危险因素。
我们对2014年5月至2023年10月在Severance医院接受治疗的癌症患者进行了回顾性分析。所有患者对化疗或单克隆抗体均出现即刻HSR，并接受了两袋（用于1级反应）或四袋（用于2至3级反应）的11步RDD方案。
对213例患者共进行了1010次RDD操作（157次基于铂类药物，31次紫杉烷类，16次单克隆抗体，9次其他药物）。其中，259次操作使用两袋方案，751次使用四袋方案。207次操作（20.4%）出现BTR，涉及113例患者（53%）。大多数BTR（n = 91）与铂类药物有关，15例导致治疗中断。逻辑回归显示，严重的初始HSR（比值比 = 2.101，95%置信区间 = 1.348 - 3.276，P = .001）和更高的化疗药物暴露频率（比值比 = 1.075，95%置信区间 = 1.010 - 1.144，P = .023）显著增加了中重度BTR的风险。总体而言，95.8%的患者完成了1个或更多治疗周期。
这种11步RDD方案在不同的癌症患者群体中是安全有效的。它还表明更严重的初始HSR、先前高剂量暴露于化疗药物与BTR的发生之间存在直接关联。
