Safety, Costs, and Efficacy of Rapid Drug Desensitizations to Chemotherapy and Monoclonal Antibodies David Sloane, MD, EdM, Usha Govindarajulu, PhD,

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Presentation transcript:

Safety, Costs, and Efficacy of Rapid Drug Desensitizations to Chemotherapy and Monoclonal Antibodies David Sloane, MD, EdM, Usha Govindarajulu, PhD, Jacob Harrow-Mortelliti, BA, William Barry, MD, PhD, Florence Ida Hsu, MD, David Hong, MD, Tanya Laidlaw, MD, Ross Palis, MD, Henry Legere, MD, Supinda Bunyavanich, MD, Rebecca Breslow, MD, Duane Wesemann, MD, PhD, Nora Barrett, MD, Patrick Brennan, MD, PhD, Hey Jin Chong, MD, Anne Liu, MD, James Fernandez, MD, Laura Fanning, MD, Timothy Kyin, MD, Katherine Cahill, MD, Lora Bankova, MD, Ashly Lynch, BA, Suzanne Berlin, DO, Susana Campos, MD, Charles Fuchs, MD, MPH, Robert Mayer, MD, Ursula Matulonis, MD, Mariana Castells, MD, PhD The Journal of Allergy and Clinical Immunology: In Practice Volume 4, Issue 3, Pages 497-504 (May 2016) DOI: 10.1016/j.jaip.2015.12.019 Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure 1 Desensitization protocol: example of a 4-bag, 16-step protocol. A patient presenting with a grade 3 anaphylactic reaction to gemcitabine was desensitized in the intensive care unit with 4 bags (250 mL) and 16 steps (15 minutes each step except for step 16). Four solutions were made as follows: solution 1 was a 1000-fold dilution of the final target concentration (steps 1-4), solution 2 was 100-fold dilution (steps 5-8), solution 3 was 10-fold dilution (steps 9-12), and solution 4 was calculated by subtracting the cumulative dose delivered in steps 1-12 from the total target dose (steps 13-16). The total time was 6.7 hours, and at the end of the desensitization protocol the full target dose was infused. The Journal of Allergy and Clinical Immunology: In Practice 2016 4, 497-504DOI: (10.1016/j.jaip.2015.12.019) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure 2 Safety of desensitizations. The overall number and severity of breakthrough reactions occurring during all desensitization courses is shown as a total of all desensitizations (2177) (A) and for carboplatin, rituximab, and paclitaxel, the most commonly desensitized drugs (B). Reactions at each step of the desensitization protocols are shown for chemotherapy and for monoclonal antibodies (C). Reactions after step 12 are indicated as >12 and delayed reactions as “d.” The Journal of Allergy and Clinical Immunology: In Practice 2016 4, 497-504DOI: (10.1016/j.jaip.2015.12.019) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure 3 Survival and costs of desensitizations. Numbers of patients in each group are shown. Actual patient encounters involve patient returns to BWH outside of any standard oncology visits and DFCI. The average, compared by a 2-sample t-test, and total costs of these encounters are given during the time period 2007-2010. BWH, Brigham and Women's Hospital; DFCI, Dana Farber Cancer Institute. The Journal of Allergy and Clinical Immunology: In Practice 2016 4, 497-504DOI: (10.1016/j.jaip.2015.12.019) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions