P17.41.A THE PHENOMENON OF HYPERSENSITIVITY REACTIONS TO PROCARBAZINE LOMUSTINE VINCRISTINE (PCV) REGIMEN AND ITS COMPONENTS IN PATIENTS WITH DIFFERENT GLIOMA TYPES.

Abstract INTRODUCTION There components of the Procarbazine Lomustine Vincristine (PCV) regimen have important role in glioma treatment. The adverse events are known, but the hypersensitivity reactions are considered rare events. The aim of the study is to characterize the hypersensitivity reactions to PCV regimen and its components in patients with gliomas. METHODS We retrospectively evaluate the electronic medical records (EMR) of adult glioma patients who were treated by PCV regimen and its components in Sheba medical center. Patients were divided to groups 1/2/3/4/ Glioblastoma/IDH mutated 1p19q non co-deleted WHO3/ IDH mutated 1p19q non co-deleted WHO2/IDH mutated 1p19q co-deleted WHO2 and WHO3 gliomas respectively. Data was extracted from the EMR using SQL software, OncoMind RWD of the Jusidman Cancer Center in Sheba medical center. RESULTS Of the 65 patients identified in our database 65% /1.5%/7.69%/27.6% were patients of 1/2/3/4 groups respectively. The groups included male /female patients 26/13 in group 1, 2/3 in group 3, 10/5 in group 4, only 1 patient was in group 2. The mean age was 56.5/46/23/46.5 years in 1/2/3/4 group respectively. All patients in groups 2-4 were treated with PCV or PC, in group one 13/19/2/5 patients were treated with PC/lomustine-bevacizumab/lomustine-temozolomide/ lomustine single agent respectively. In groups 2, 3 and 4 all patients and in group one 41% of patients were off steroids. The hypersensitivity reactions were registered in group 4 patients only (6 patients, 27.7%), of those 4 were female. The causes of the reactions were lomustine/procarbazine/lomustine and procarbazine in 3/2/1 patients respectively. Only 1 patient had a hypersensitivity reaction previously. All events were registered during the first 3 cycles of treatment and presented with skin symptoms, one patient developed angioedema. All patients were evaluated in allergy and immunology clinic and patch skin tests were performed as required. In all cases late type of hypersensitivity was diagnosed. All patients continued treatment with premedication, in 4 of them the treatment was terminated due to the severity of the reactions, 1 patient refused the treatment, one patient did continue the treatment with desensitization procedure. CONCLUSION The phenomenon of hypersensitivity reactions to the PCV regimen and its components were restricted to patients with IDH mutated 1p19q co-deleted gliomas. The predominance of female patients correlates with higher prevalence of hypersensitivity reactions in female in general. The absence of hypersensitivity reactions in glioblastoma patients could be partially explained by steroids effect in on steroid patients but unclear in off steroids patients. The significance of hypersensitivity reactions on gliomas course is currently obscure and have to be studded on larger patient’s population.