Assessment of Confirmed Clinical Hypersensitivity to Rituximab in Patients Affected with B-Cell Neoplasia. (11th June 2020)

• Record Type: Journal Article
• Authors: Novelli, S.; Soto, L.; Caballero, A.; Moreno, M. E.; Lara, M. J.; Bayo, D.; Quintas, A.; Jimeno, P.; Zamora, M. I.; Bigorra, T.; Sierra, J.; Briones, J.
• Other Names: Lwaleed Bashir A. Academic Editor.
• Is Part Of: Advances in hematology. Volume 2020(2020)
• Publication Date: 2020-06-11
• Subjects: Hematology -- Periodicals; Hematologic Diseases; Hematology; Hematology; Periodicals; Periodicals; 616.15
• DOI: 10.1155/2020/4231561
• Languages: English
• ISSNs: 1687-9104

Abstract

Abstract : Rituximab hypersensitivity reactions are rare but are one of the main causes of rituximab elimination from antilymphoma immunochemotherapy treatments. While the clinical picture may be indistinguishable from other infusion-related reactions, hypersensitivity reactions (HSR) do not disappear and instead become more intense with subsequent administrations. Objective . To describe the use of the 12-step protocol for desensitization to intravenous rituximab in clinical practice and the complementary study of a possible IgE-mediated HSR in the context of B-cell lymphoma treatment. Methods . A 12-step rituximab desensitization protocol was performed prospectively within clinical practice in 10 patients with a history of severe infusion reactions or in patients who had a repeated reaction at subsequent doses despite taking more intense preventive measures. Skin prick tests were performed at the time of reaction and at a later time to eliminate false negatives due to possible drug interference. Results . Overall, with the desensitization protocol, 70% of patients were able to complete the scheduled immunochemotherapy. Two patients had to discontinue the therapy due to clinical persistence and the third due to lymphoma progression. Intradermal tests with 0.1% rituximab were positive in only 20% of cases, demonstrating a mechanism of hypersensitivity. Conclusions . The 12-step desensitization protocol is very effective and assumable within healthcare practice. There is a need to determine the mechanism underlying the infusion reaction in a large proportion of cases due to the risk of future drug exposure.