Multiple successful desensitizations to brentuximab vedotin: a case report and literature review.
Brentuximab vedotin is an antibody-drug conjugate FDA-approved for the treatment of systemic anaplastic large-cell lymphoma (ALCL) that has relapsed after multiagent chemotherapy. At least 2 cases of hypersensitivity reactions to brentuximab vedotin have been reported, without attempted desensitization. This report describes a morbidly obese 32-year-old woman with ALCL that relapsed after autologous stem cell transplantation, who was treated on a phase II clinical study with brentuximab vedotin. After 1 dose, she experienced near-complete remission, but therapy was stopped because of severe drug-related toxicity. She then received 5 cytotoxic treatments and radiation, and ultimately experienced disease progression. The patient was rechallenged with brentuximab vedotin approximately 28 months after initial exposure and tolerated the dose well, but experienced a significant allergic reaction with the next dose. High-dose steroid and antihistamine prophylaxis administered 50 minutes before the subsequent brentuximab vedotin infusion was unsuccessful in mitigating this reaction. Brentuximab vedotin was successfully infused according to a rapid desensitization protocol. With progressive dose titration and supportive care, the patient tolerated this therapy. She received 11 doses through a rapid desensitization protocol and experienced a durable disease remission.
From the aDepartment of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; bDivision of Hematology/Oncology, Tufts University School of Medicine, Tufts Medical Center, Boston, Massachusetts; and cDivision of Hematology/Oncology, Northwestern University Feinberg School of Medicine, dRobert H. Lurie Comprehensive Cancer Center of Northwestern University, and eDivision of Allergy/Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Michael D
MD
DeVita
Andrew M
AM
Evens
Steven T
ST
Rosen
Paul A
PA
Greenberger
Adam M
AM
Petrich
D000328:Adult; D000079963:Brentuximab Vedotin; D003888:Desensitization, Immunologic / Q000379:methods*; D004342:Drug Hypersensitivity / Q000517:prevention & control*; D005260:Female; D006801:Humans; D018796:Immunoconjugates / Q000009:adverse effects / Q000276:immunology*; D017728:Lymphoma, Large-Cell, Anaplastic / Q000188:drug therapy*
D018796:Immunoconjugates; D000079963:Brentuximab Vedotin