title: Prevention and management of obinutuzumab-associated toxicities: Australian experience.
abstract: Patients with chronic lymphocytic leukaemia (CLL) are typically diagnosed at an advanced age and may have multiple co-existing conditions, augmenting the challenges of treating their CLL. Aggressive cytotoxic therapies are often poorly tolerated in this patient population. Obinutuzumab is a glycoengineered type II anti-CD20 monoclonal antibody indicated in combination with chlorambucil for previously untreated CLL. The approval of this drug was based on the pivotal CLL11 trial, which demonstrated longer progression-free survival vs. rituximab/chlorambucil and chlorambucil alone in patients with significant co-existing medical conditions and/or poor renal function. However, a higher risk of infusion-related reactions (IRRs) was demonstrated with obinutuzumab-based therapy. We highlight important nursing care considerations to help prevent and successfully manage IRRs and other important adverse events, to improve the treatment experience of patients receiving obinutuzumab infusions and to enable them to complete their treatment and receive optimal benefit. Premedication, drug handling, dosing, administration, monitoring and documentation are discussed.
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Alicia
authors.initials: A
authors.lastname: Snowden
authors.affiliation: St John of God Subiaco Hospital, Perth, Australia.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Hayden
authors.affiliation: Roche Products Pty. Ltd, Dee Why, NSW, Australia.
authors.forename: Joanna
authors.initials: J
authors.lastname: Dixon
authors.affiliation: Monash Haematology, Monash Health, Clayton, Victoria, Australia.
authors.forename: Gareth
authors.initials: G
authors.lastname: Gregory
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001315:Australia; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; C543332:obinutuzumab
keywords: Obinutuzumab; chronic lymphocytic leukaemia; cytokine release syndrome; infusion-related reaction; nursing; tumour lysis syndrome