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Human parvovirus infection typically causes transient red blood cell aplasia. However, contrary to common perceptions, the hematopathologic effects of parvovirus infection are not always limited to the erythroid lineage. We describe here a consecutive series of 17 patients with chronic hemolytic anemia hospitalized for aplastic crisis, of whom 13 had transient hypoplasia of multiple peripheral blood cell lines.

Introduction: Acute lymphoblastic leukemia (ALL) is the most common type of pediatric cancer. Unfortunately, approximately 15% of children with high-risk B-cell ALL (B-ALL) relapse after frontline chemotherapy. Treatment of relapsed/refractory B-ALL is still challenging, and more effective novel therapies are urgently warranted. Blinatumomab, a first in class bispecific antibody therapeutic, has demonstrated superiority compared to standard chemotherapy in patients with B-ALL and has a manageable toxicity profile. Blinatumomab functions by binding to CD19 expressed on B-cells and CD3 expressed on T-cells, resulting in T-cell-mediated killing of CD19-positive cells common in B-cell malignancies. Despite remarkable efficacy and a manageable toxicity profile compared to standard-of-care chemotherapy, blinatumomab poses unique healthcare system challenges related to preparation, administration, toxicity monitoring, and medication error prevention. The drug's success in helping patients achieve complete remission relies on its continuous and uninterrupted administration. In order to ensure that it is delivered in the safest and most effective manner, education on its unique logistical and administration challenges is imperative. Objectives: The primary objective of this study is to describe and share the 6 years of institutional experience on the outpatient delivery of blinatumomab for the management of pediatric patients with B-ALL as per Children's Oncology Group protocols, as well as to retrospectively analyze the safety of this novel 28-day home-based therapy. Methods: A multidisciplinary team composed of physicians, nurses, and pharmacists was created to address administration challenges associated with blinatumomab infusions. Although blinatumomab requires a 28-day continuous infusion, it is not necessary for patients to remain hospitalized for the entire cycle. To ensure tolerability prior to discharge, patients are monitored closely during the first 3 days of Cycle 1 and 2 days of Cycle 2 for signs of cytokine release syndrome and neurological toxicities. Once discharged, they are seen every 96/72 hours for bag changes in either an outpatient hematology/oncology unit or by home health for those off study. Results: A total of 16 patients were treated with blinatumomab between May 2015 and June 2021; 10 were newly diagnosed and 6 were in first relapse. Of the 26 total infusions, 24 were successfully completed without significant adverse reactions. Two patients treated for relapsed disease had to discontinue therapy; one experienced neurotoxicity within 72 hours of blinatumomab infusion initiation and the other developed refractory disease and was switched to another protocol. No adverse events were observed in the home setting. Discussion: The team was successfully able to transform the original inpatient-only blinatumomab protocol to the outpatient setting. Retrospective analysis over 6 years demonstrates a clinically significant reduced rate of complications of blinatumomab administration in comparison to previous reports (Amicucci et al. 2021), which can be attributed to careful multidisciplinary team planning and delivery. This study confirms the feasibility of a home-based continuous blinatumomab infusion without adverse effects on safety. Additionally, this outpatient protocol leads to cost savings associated with reduced length of stay and an overall improved quality of life for pediatric patients able to receive therapy at home with their caregivers. Disclosures No relevant conflicts of interest to declare.

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Introduction Hypersensitivity reactions (HSRs) can be induced by many medications, including chemotherapy agents and monoclonal antibodies (mAbs). Virtually all chemotherapeutics have the potential to initiate infusion reactions. Allergies to chemotherapeutics and biologic agents usually manifest with skin symptoms (rash, itching, and swelling), angioedema, or even potentially fatal anaphylactic reactions. Medication allergies may lead to discontinuation of life-prolonging therapies and therefore worsen prognosis. For clinical situations where hypersensitivity reactions prevent administration of a critical medication, desensitization can be an extremely useful addition to the clinical toolkit. In the early 2000s, multiple clinical trials showed that Rapid Drug Desensitization (RDD) for chemotherapy and mAbs was safe and effective in improving clinical outcomes and allowing patients to remain on preferred first-line therapy. Desensitization is challenging however, and this is reflected in variable success rates reported in the literature. One recent review noted successful desensitization in anywhere from 20 to 75% of cases (Ruggiero et al. 2017). This wide range is likely due to different methods of desensitization used in various studies. There are multiple variables influencing the success of desensitization, including the starting dose, the infusion rate, and the number of increments. Desensitization protocols are often complex requiring multiple changes in the rate and volume of medication administered between steps--making it difficult to complete them correctly. We have developed a new, simpler desensitization method that does not require multiple changes in the infusion rate and volume, thus reducing clinical confusion and leading to improved patient outcomes. Methods We developed a standardized protocol for rapid desensitization in patients who had hypersensitivity reactions to carboplatin or rituximab. This new desensitization method utilizes the same rate, administration time, and volume for each dose, only changing the drug concentration gradually between steps. This method helps minimize the chance of errors that occur due to repeatedly reprogramming the rate and volume of the infusion. A total of 10 patients were treated under this desensitization protocol between November 2017 and June 2020 for a total of 76 desensitization episodes. Initial desensitization occurred in the medical intensive care unit and subsequent infusions of carboplatin took place in an outpatient hematology-oncology setting. We retrospectively analyzed safety and efficacy of this novel desensitization protocol through review of treatment records. Results Of the 76 desensitizations performed, no adverse reactions occurred during desensitization and patients received their full target dose in all cases. No breakthrough reactions were noted during subsequent infusions of carboplatin or rituximab in desensitized patients. To prevent breakthrough reactions, antihistamines, corticosteroids and a leukotriene modifier were administered as pre-medications. Patients undergoing carboplatin desensitization were able to be switched from a 12-step protocol to a 10-step protocol with the same 100 % success rate in completing the entire planned cycle of chemotherapy. Discussion This retrospective analysis demonstrated a statistically and clinically significant reduced rate of breakthrough reactions in comparison to previous reports (Brennan et al. 2009). The other benefits of this novel method include improvement in safety of administration and cost savings. Disclosures No relevant conflicts of interest to declare.