Journal of Clinical Oncology, Vol 11, 1080-1084, Copyright © 1993 by American Society of Clinical Oncology
Acute hypersensitivity reactions to etoposide in a VEPA regimen for Hodgkin's disease
MM Hudson, HJ Weinstein, SS Donaldson, C Greenwald, L Kun, NJ Tarbell, WA Humphrey, C Rupp, NM Marina and J Wilimas
Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38101.
PURPOSE: We report an unexpectedly high incidence of hypersensitivity to
etoposide among 45 patients with newly diagnosed Hodgkin's disease treated
with vinblastine, etoposide, prednisone, and doxorubicin (VEPA) plus
radiation. PATIENTS AND METHODS: Twenty-three of 45 patients (51%) had one
or more acute hypersensitivity reactions to etoposide administration. The
23 patients were 8 to 18 years of age (median, 15 years); 12 were males.
Four patients had experienced prior allergic reactions to antibiotics or
intravenous contrast media. RESULTS: Hypersensitivity reactions followed
the first or second dose of VEPA in most cases. The reactions occurred at a
median time of 5 minutes (range, 3 to 120) from the start of the etoposide
infusion. Fifteen patients reacted early (within 10 minutes), four midway
through the infusion, and four after completion of the infusion. Signs and
symptoms included flushing, respiratory problems, changes in blood
pressure, and abdominal pain with or without nausea and vomiting.
Respiratory problems included dyspnea, chest pain/tightness, bronchospasm,
and cyanosis. Symptoms were alleviated by discontinuing the etoposide
infusions and administering diphenhydramine and/or hydrocortisone;
epinephrine was required to reverse bronchospasm in three cases. All 23
patients recovered without adverse sequelae and were rechallenged with
etoposide. Fifteen patients tolerated subsequent etoposide infused at a
slower rate, with antihistamine and/or corticosteroid premedication; five
had recurrent hypersensitivity despite these measures. Three of these five
developed similar symptoms when teniposide was substituted for etoposide.
Three patients who had isolated episodes of hypotension on completion of
the etoposide infusion successfully received subsequent infusions without
premedication or change in infusion rate or concentration. CONCLUSION:
Despite this unexpectedly high incidence of hypersensitivity among
Hodgkin's disease patients treated with etoposide, rechallenge with the
drug was successful in 78% of cases.
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