Gutiérrez-Fernández Diego, Saldaña-Valderas Mónica, de la Varga-Martínez Raquel, Foncubierta-Fernández Antonio, Fernández-Anguita María J, Fernández-Valle Maria Del C, Medina-Varo Fermín
1 Servicio de Alergología. UGC Neumología-Alergia, Hospital Universitario Puerta del Mar, Cádiz, Spain.
2 UGC Farmacología Clínica, Hospital Universitario Puerta del Mar, Cádiz, Spain.
J Oncol Pharm Pract. 2019 Jun;25(4):1016-1020. doi: 10.1177/1078155218775473. Epub 2018 May 23.
We describe a successful desensitization to alemtuzumab in one patient diagnosed with T-cell prolymphocytic leukaemia. Alemtuzumab treatment was initiated during infusion number 18, the patient showed cutaneous eruption with a miliary pattern, despite premedication with corticosteroids and antihistamines. The eruption returned with successive alemtuzumab infusions (infusions 19, 20 and 21), remained present for longer and was more severe with each infusion. The patient was referred to our Allergy Unit as it was necessary to maintain alemtuzumab treatment. Total immunoglobulin E level was 3 UI/ml and specific immunoglobulin E against more common pneumo-allergens, food, latex and hamster were inferior to 0.35 UI/ml. Prick test using the undiluted drug (30 mg/ml) and intradermal tests using serial dilutions (1/10, 1/100) were performed. The result of alemtuzumab skin prick test was 4 mm. The intradermal skin test result was positive at 1/100 dilution (papule: 8 mm; erythema: 12 mm). The basophil activation test with alemtuzumab was performed concluding that 10% of the basophils were activated by alemtuzumab. The patient underwent alemtuzumab desensitization according to a 12-step protocol that resolved to be safe and efficacious. Our experience may be helpful for similar clinical cases where the therapeutic options are very limited and a life-threatening condition such T-cell prolymphocytic leukaemia is present. In addition, a careful risk/benefit ratio should be considered and accurate informed consent is mandatory.
我们描述了一例被诊断为T细胞幼淋巴细胞白血病患者成功进行阿仑单抗脱敏治疗的病例。在第18次输注期间开始阿仑单抗治疗，尽管预先使用了皮质类固醇和抗组胺药，但患者仍出现粟粒样皮疹。在随后的阿仑单抗输注（第19、20和21次输注）过程中皮疹复发，持续时间更长，且每次输注时皮疹更严重。由于需要维持阿仑单抗治疗，该患者被转诊至我们的过敏科。总免疫球蛋白E水平为3 UI/ml，针对更常见的肺炎过敏原、食物、乳胶和仓鼠的特异性免疫球蛋白E低于0.35 UI/ml。使用未稀释药物（30 mg/ml）进行点刺试验，并使用系列稀释液（1/10、1/100）进行皮内试验。阿仑单抗点刺试验结果为4 mm。皮内试验结果在1/100稀释度时呈阳性（丘疹：8 mm；红斑：12 mm）。进行了阿仑单抗嗜碱性粒细胞活化试验，结果显示10%的嗜碱性粒细胞被阿仑单抗激活。该患者按照12步方案进行了阿仑单抗脱敏治疗，结果证明该方案安全有效。我们的经验可能有助于处理类似的临床病例，在这些病例中治疗选择非常有限，且存在如T细胞幼淋巴细胞白血病这样危及生命情况的患者。此外，应仔细考虑风险/收益比，并且必须获得准确的知情同意。
