Overcome Daratumumab' severe reaction with desensitization in relapsed multiple myeloma.

IF 1 4区 医学 Q4 ONCOLOGY
Trang L Nguyen, Truc Phan, Mai T Vu, Kn Vy Huynh, Yi Hyeon Gyu, Tuan D Nguyen, Lan Q Phan, Tuan D Nguyen, Dinh V Nguyen
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Abstract

IntroductionDaratumumab, a monoclonal antibody that specifically targets the myeloma cells' CD38 antigen, is promisingly used in both monotherapy and combination therapy for relapsed patients with multiple myeloma. However, this approach had a significant challenge due to the high rate of infusion-related reaction in the first dosage (up to 38%) despite strict instructions on infusion rate and dilution volume. This study describes a patient who overcame severe infusion reaction after the first dosage by desensitization.Case reportA 60-year-old man with multiple myeloma was relapsed with multiple bone damage and elevated immunoglobulin D lambda after VTD (bortezomid, thalidomide, dexamethasone) regimen completion. After 60 min of initial Daratumumab dose with sufficient pre-medication, the patient manifested suspected grade 3 infustion reaction and was transported to the intensive care unit.Management and outcomeDaratumumab was immediately terminated; adrenaline, methylprednisolone, and diphenhydramine were started. Another regimen was performed. However, due to substantial progression of symptoms, a re-introduction of daratumumab was considered. Daratumumab prick and intradermal skin test was performed with negative result. Desensitization were sucessfull with the number of bags and steps gradually lowered with no adverse events observed. After three cycles, the patient achieved VGPR (Very Good Partial Response) without any symptomatic spinal cord compression.ConclusionDesensitization is a promising solution to overcome daratumumab's severe infusion reaction, opening the new approach for clinicians. To ensure success, it is important to have a multidisciplinary team with experienced allergist, hematologist, Intensive Care Init (ICU) team and oncology pharmacist to create a safe environment for desensitization.

在复发性多发性骨髓瘤中克服达拉单抗的严重反应和脱敏。
daratumumab是一种特异性靶向骨髓瘤细胞CD38抗原的单克隆抗体,有望用于多发性骨髓瘤复发患者的单药和联合治疗。然而,尽管对输注速率和稀释体积有严格的说明,但由于第一次剂量的输注相关反应率高(高达38%),这种方法面临重大挑战。本研究描述了一位患者在第一次给药后通过脱敏克服了严重的输注反应。病例报告:一名60岁男性多发性骨髓瘤患者在完成VTD(硼替佐米、沙利度胺、地塞米松)治疗后,多发性骨损伤复发,免疫球蛋白D升高。在给予充分的达拉单抗初始剂量60分钟后,患者表现出疑似3级输液反应,并被送往重症监护病房。管理和结果:aratumumab立即终止;开始使用肾上腺素、甲基强的松龙和苯海拉明。进行另一种治疗方案。然而,由于症状的显著进展,考虑重新引入达拉单抗。达拉单抗点刺及皮内试验均为阴性。脱敏成功,袋数和步数逐渐减少,无不良事件发生。三个周期后,患者达到了VGPR(非常好的部分反应),没有任何症状性脊髓压迫。结论脱敏治疗是克服达拉单抗严重输液反应的有效方法,为临床医生开辟了新的途径。为了确保成功,重要的是要有一个多学科的团队,由经验丰富的过敏症专家、血液学家、重症监护(ICU)团队和肿瘤药剂师组成,为脱敏创造一个安全的环境。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.70
自引率
7.70%
发文量
276
期刊介绍: Journal of Oncology Pharmacy Practice is a peer-reviewed scholarly journal dedicated to educating health professionals about providing pharmaceutical care to patients with cancer. It is the official publication of the International Society for Oncology Pharmacy Practitioners (ISOPP). Publishing pertinent case reports and consensus guidelines...
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