Utility of Risk Stratification for Paclitaxel Hypersensitivity Reactions.

Utility of Risk Stratification for Paclitaxel Hypersensitivity Reactions.

J Allergy Clin Immunol Pract. 2017 Oct 03;:

Authors: Otani IM, Lax T, Long AA, Slawski BR, Camargo CA, Banerji A

Abstract
BACKGROUND: Hypersensitivity reactions (HSRs) are a common impediment to paclitaxel therapy. Management strategies to guide care after a paclitaxel-induced HSR are needed.
OBJECTIVE: The objective was to evaluate the utility and safety of risk stratification on the basis of severity of the initial HSR.
METHODS: A risk stratification pathway was developed on the basis of a retrospective review of the management and outcome of 130 patients with paclitaxel-induced HSRs at Massachusetts General Hospital. This pathway was then studied prospectively in patients referred to Allergy/Immunology with paclitaxel-induced HSRs.
RESULTS: The study population (n = 35) had a mean age of 56.1 ± 12 years and most were women (n = 33 [94%]). All 5 patients (15%) with grade 1 initial HSRs were successfully reexposed to paclitaxel, 1 patient at the standard infusion rate and 4 patients at 50% of the standard infusion rate. Thirty patients (85%) with grade 2 to 4 initial HSRs underwent initial paclitaxel desensitization based on the risk stratification pathway. No patients developed severe HSRs using the pathway. Eleven (31%) patients had HSRs that were mild to moderate in nature (grade 1, n = 4 [11%]; grade 2, n = 6 [17%]; grade 3, n = 1 [3%]) during their first desensitization. Sixteen (46%) of the 35 patients safely returned to the outpatient infusion setting for paclitaxel treatment at 50% of the standard infusion rate. Seven (20%) discontinued paclitaxel before the completion of the risk stratification pathway because of disease progression, completion of therapy, or death.
CONCLUSIONS: A management strategy using the initial HSR severity for risk stratification allowed patients to receive paclitaxel safely.

PMID: 28986119 [PubMed - as supplied by publisher]

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