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

Abstract

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.

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

“…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.…”