单中心奥沙利铂超敏反应的处理及转归真实世界研究

王闫飞; 付巧英; 陈晓艳; 夏丽娜; 刘钟芬; 姜丹凤; 郑艳群; 张红; 刘巍

doi:10.3969/j.issn.1000-8179.2020.14.683

单中心奥沙利铂超敏反应的处理及转归真实世界研究

doi: 10.3969/j.issn.1000-8179.2020.14.683

王闫飞^①,,
付巧英^①,
陈晓艳^①,
夏丽娜^②,
刘钟芬^②,
姜丹凤^①,
郑艳群^①,
张红^①,
刘巍^{①, ②, ,}

①.
北京大学肿瘤医院暨北京市肿瘤防治研究所日间化疗病区, 恶性肿瘤发病机制及转化研究教育部重点实验室(北京市 100142)
②.
姑息治疗中心

基金项目:

北京市医院管理局“使命”计划专项经费项目 SML20181102

中华人民共和国人力资源和社会保障部百千万工程领军人才万人计划项目 2221-14-017

详细信息

作者简介:
王闫飞专业方向为恶性肿瘤内科治疗及症状管理。E-mail:yfwangfaith@gmail.com

通讯作者:
刘巍 newbeijingliuwei@163.com

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- 被引次数: 0
出版历程
- 收稿日期: 2020-05-12
- 刊出日期: 2020-12-26

Management and outcome of hypersensitivity reactions to oxaliplatin: a real-word study in a single center

Wang Yanfei^{①
,},
Fu Qiaoying^①,
Chen Xiaoyan^①,
Xia Lina^②,
Liu Zhongfen^②,
Jiang Danfeng^①,
Zheng Yanqun^①,
Zhang Hong^①,
Liu Wei^{①, ②
, ,}

①.
Daycare Center, Peking University Cancer Hospital&Institute, Beijing 100142, China
②.
Palliative Care Center, Key laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing), Peking University Cancer Hospital&Institute, Beijing 100142, China

Funds:

This work was supported by Beijing Municipal Administration of Hospitals' Mission Plan SML20181102

The Leading Talents of Science and Technology Innovation in the National "Ten thousand Talents Program" 2221-14-017

More Information

Corresponding author: Wei Liu; E-mail:newbeijingliuwei@163.com

摘要

摘要: 目的通过对输注奥沙利铂导致的超敏反应的临床特点、处理方式和临床转归进行分析，为临床诊治提供依据。方法回顾性分析2015年1月至2017年12月北京大学肿瘤医院上报国家药品不良反应监测中心的62例奥沙利铂超敏反应患者的临床资料，按国际通用标准分型为标准输液反应与严重过敏反应，分析其临床特征、超敏反应亚型、严重程度分级、处理方式及转归。结果患者平均年龄（52.9±11.3）岁，男女比例1.07：1。59.7%（37/62）患者在输注奥沙利铂前使用了糖皮质激素预处理。发生超敏反应时奥沙利铂中位治疗为6（4~7.25）个周期，中位累积剂量456.9（263.5~651.0）mg/m²。30.6%（19/62）患者存在无奥沙利铂间隔期。41例（66.1%）患者诊断为标准输液反应，21例（33.9%）诊断为严重过敏反应。在处理方式上，所有患者均采取了暂停用药、更换输液器的处理，无患者使用肾上腺素；所有患者症状均缓解，无死亡病例。58.6%（17/29）需要继续进行治疗的2级标准输液反应患者进行了再次用药，其中70.6%（12/17）未再次出现超敏反应。结论临床对奥沙利铂输注前预处理不足，严重过敏反应的肾上腺素的一线使用尚未得到足够重视，大部分轻中度奥沙利铂超敏反应后续可再次安全用药。
- 奥沙利铂 /
- 超敏反应 /
- 标准输液反应 /
- 过敏反应 /
- 再用药
Abstract: Objective To review the clinical characteristics of patients with hypersensitivity to oxaliplatin, symptom management, and treatment outcomes to guide further treatment. Methods From January 2015 to December 2017, 62 cases of hypersensitivity reactions to oxaliplatin were reported to the National Center for Adverse Drug Reaction(ADR) Monitoring in the Daycare Center of Peking University Cancer Hospital & Institute. The hypersensitivity reactions were classified into standard infusion-related reactions and anaphylaxis in accordance with international standards. The clinical data, treatment information, and outcomes of these patients were retrospectively collected and analyzed. Results The mean age of the 62 patients was (52.9±11.3) years, the male-to-female radio was 1.07:1, and 59.7% (37/62) of patients received premedication with glucocorticoids before oxaliplatin. The median onset time was 6 (interquartile range 4-7.25) cycles with a median cumulative dose of 456.9 (263.5-651.0) mg/m². Of the 62 patients, 19 (30.6%) patients had an oxaliplatin-free interval, 41 (66.1%) patients were diagnosed with a standard infusion-related reaction, and 21 (33.9%) patients were diagnosed with anaphylaxis based on clinical criteria. The medication was suspended for all patients and the infusion set was replaced. No patient received epinephrine for symptom management. All patients recovered completely; no deaths were reported. In addition, 58.6% (17/29) of patients with grade 2 standard infusion-related reactions who need further treatment were subsequently rechallenged with oxaliplatin, 70.6% (12/17) showed no symptoms of hypersensitivity. Conclusions Premedication before oxaliplatin was not sufficient and the management of hypersensitivity was not standardized; therefore, the first-line usage of epinephrine should be performed with caution. Most cases of moderate hypersensitivity for soxaliplatin can be rechallenged successfully.
- soxaliplatin /
- hypersensitivity /
- standard infusion-related reaction /
- anaphylaxis /
- rechallenge

HTML全文

图 1 发生超敏反应后后续治疗情况

下载: 全尺寸图片幻灯片

图 2 首次发生超敏反应后再治疗周期数

下载: 全尺寸图片幻灯片

表 1 不同亚型超敏反应患者的临床特征

表 2 不同亚型超敏反应的临床症状及体征 n(%)

表 3 不同亚型超敏反应的发生时间、治疗、转归及再用药情况

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