Cyclophosphamide desensitization in patients with severe hypersensitivity reactions to bendamustine

Abstract

Introduction Cyclophosphamide is a nitrogen mustard alkylator employed in the treatment of many malignancies and autoimmune disorders. Despite reports of cyclophosphamide hypersensitivity ranging from rash to anaphylaxis, no cases of desensitization have been reported in the oncologic setting. Case report We report a cyclophosphamide desensitization protocol used for two patients who experienced severe hypersensitivity to bendamustine, a structurally related drug with potential cross immunogenicity. Management and outcome An interdisciplinary approach including immunologist, oncologist, and clinical pharmacists resulted in the development of a multi-step desensitization protocol for cyclophosphamide. The desensitization protocol described enabled the safe administration of cyclophosphamide for the two patients with limited treatment alternatives. Discussion To the authors' knowledge, this is the first report of cyclophosphamide desensitization in the oncologic setting. Two patients with advanced hematologic malignancies were able to receive cyclophosphamide with minimal adverse effects, despite experiencing previous severe hypersensitivity to another nitrogen mustard analogue.

Study of immune responses in mice to oral administration of Flor�Essence

“…In the present study, increases in the proliferation of splenocytes, phagocytosis of macrophages and cytotoxicity of NK cells towards K562 cells were observed following FE treatment in a mouse model of CP-induced immunosuppression. The mechanism of CP-induced immunosuppression is similar to that of nitrogen mustard (42). CP is crosslinked with DNA to inhibit the synthesis of DNA and interfere with RNA function, inhibit tumor growth; however, when killing tumor cells, CP can damage the immune organs and inhibit humoral immunity (43).…”

Combination strategies to optimize the efficacy of chimeric antigen receptor T cell therapy in haematological malignancies

“…Alternative regimens are also being explored. Bendamustine is a safer and more tolerable chemotherapy agent with no crossresistance to Cy (42). In the JULIET trial, bendamustine was used for B-NHL patients who were resistant to Cy (7).…”