Desensitization of Brentuximab Vedotin in a Patient with Hodgkin Lymphoma

Khalid, Sidra; Khalid, Aariez; Clark, Bernadette A; Daw, Hamed

doi:10.7759/cureus.2981

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…In clinical trials using brentuximab vedotin as monotherapy, 13% of patients experienced an infusion reaction, out of which 1.2% of patients had severe anaphylaxis. 8 HSRs to BV seem to be the result of initial sensitization during the first infusion, and reactions of progressive severity occur during subsequent infusions. It is speculated that BV HSRs may be mediated by human anti-mouse antibodies which has been reported in the clinical trials.…”

Section: Discussionmentioning

confidence: 97%

Rapid desensitization to brentuximab vedotin after severe anaphylaxis in the treatment of refractory Hodgkin’s lymphoma

Villarreal-González

González‐Díaz

Lira-Quezada

et al. 2020

J Oncol Pharm Pract

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Introduction Brentuximab vedotin is a monoclonal antibody drug conjugate used for the treatment of patients with Hodgkin lymphoma. Hypersensitivity reactions to brentuximab vedotin may include cutaneous, cardiovascular, respiratory, gastrointestinal and neurological signs and symptoms. Case report We present the case of a 23-year-old Mexican female with stage IV progressive classical nodular sclerosing Hodgkin lymphoma who received multiple previous chemotherapy regimens. Brentuximab vedotin at 1.8 mg/kg (180 mg total dose), for 21-day cycles was indicated. Within 5 min of infusion of the 5th cycle of brentuximab, she developed severe anaphylaxis (hives, angioedema, diaphoresis, tachycardia, dyspnea, hypoxemia and loss of consciousness), which was successfully controlled with epinephrine, steroids and antihistamines. Management and outcome: Intradermal skin test at a concentration of 0.1 mg/ml was positive. Due to the severity of the symptoms and the lack of access to alternative treatments, we performed a desensitization protocol. A total of 180 mg of brentuximab was given in three bag solutions in 12 steps, with an initial concentration dose of 1/100 of the total dose in a course of 5.56 h with no hypersensitivity reactions. Discussion Severe anaphylaxis has been reported in 1.2% of patients receiving brentuximab vedotin. Patients who are treated by rapid drug desensitization with their first option therapy present a favorable survival rate with better cost-effectiveness in comparison to second-line treatment.

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Section: Discussionmentioning

confidence: 97%

Rapid desensitization to brentuximab vedotin after severe anaphylaxis in the treatment of refractory Hodgkin’s lymphoma

Villarreal-González

González‐Díaz

Lira-Quezada

et al. 2020

J Oncol Pharm Pract

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“…Previous research trials have shown that when patients are carefully chosen concerning the type of reactions and are stratified according to risk, desensitization is a valuable alternative to allow patients to remain on first-line therapies, improving their prognosis and quality of life. [11][12][13][14][15][16] In these patients, desensitization allowed patients to achieve remission of treatment-refractory Hodgkin Lymphoma and thus be candidates for hematopoietic cell transplantation.…”

Section: Discussionmentioning

confidence: 99%

Desensitization to Brentuximab Vedotin after anaphylaxis in refractory Hodgkin's lymphoma

Villarreal-González

González-Díaz

Santos-Fernández

et al. 2022

J Oncol Pharm Pract

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Introduction Brentuximab vedotin (BV) is a monoclonal antibody that targets CD30 antigen. It is indicated for the treatment of CD30 + lymphomas and classical Hodgkin lymphoma (HL), including advanced (stage III-IV) untreated disease, relapsed/refractory disease, and consolidation after autologous hematopoietic stem cell transplantation. In clinical trials the incidence of a hypersensitivity reaction is 1.2%. Cases report We present 3 cases of patients with refractory HL and anaphylaxis to the administration of BV ( Table 1 ). Symptoms are analyzed using a grading system described by Brown (2004) and a desensitization protocol was performed with a total dose of 100 mg of BV in 4 solution bags with an initial concentration of 1:1000 of total dose for cases of severe anaphylaxis, and desensitization of 3 solution bags with baseline concentration of 1: 100 for cases of moderate anaphylaxis. Management & Outcome Intradermal skin tests were positive. Before desensitization, premedication with methylprednisolone and chlorphenamine was administered, as well as fluid therapy with 0.9% physiological solution at 100 cc/hour at induction stage, 250 cc/hour at maintenance stage, and increased to 500 cc/hour in case of hypersensitivity reaction. Discussion Drug desensitization in 12 or 16 steps allows tolerable administration of brentuximab vedotin after moderate to severe anaphylaxis. The favorable response to treatment of these patients may indicate that desensitization is a viable strategy for patients with relapsed or refractory HL.

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“…In general, there is consensus 28 that type IV cell-mediated reactions, such as EM, SJS, TEN, AGEP, and DRESS, mandate the avoidance of the implicated drug. However, some allergists recommend attempting desensitization for mild type IV delayed reactions (see Isabwe et al 9 ).…”

Section: Management Of Type IV Reactionsmentioning

confidence: 99%

Hypersensitivity to monoclonal antibodies used for cancer and inflammatory or connective tissue diseases

Hong

Sloane

2019

Annals of Allergy, Asthma & Immunology

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Hypersensitivity reactions to therapeutic monoclonal antibodies for malignant tumors and inflammatory diseases can be classic type I (mast cell mediated, perhaps IgE dependent) reactions, cytokine release reactions, or type IV cell-mediated reactions.Classic allergic reactions to monoclonal antibodies, presumed to be mast cell mediated and possibly IgE dependent, can be treated with rapid drug desensitization. Rapid drug desensitization is effective and safe for carefully selected patients, allowing them to continue to receive first-line therapy.It is dubious whether rapid drug desensitization is effectively for cytokine release reactions to monoclonal antibodies, but such reactions can be effectively limited or prevented with appropriate premedications, intravenous fluids, and dose or frequency adjustment of the monoclonal antibody.Type IV cell-mediated reactions, such as erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, and other blistering reactions are absolute contraindications to reexposure to the implicated agent.

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Desensitization of Brentuximab Vedotin in a Patient with Hodgkin Lymphoma

Cited by 3 publications

References 6 publications

Rapid desensitization to brentuximab vedotin after severe anaphylaxis in the treatment of refractory Hodgkin’s lymphoma

Rapid desensitization to brentuximab vedotin after severe anaphylaxis in the treatment of refractory Hodgkin’s lymphoma

Desensitization to Brentuximab Vedotin after anaphylaxis in refractory Hodgkin's lymphoma

Hypersensitivity to monoclonal antibodies used for cancer and inflammatory or connective tissue diseases

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