Sensitizing the interdisciplinary team to desensitizations: An alemtuzumab case report

Matt G. McKenzie, Brittany D. Bissell, Margaret A. Disselkamp, Gerhard C. Hildebrandt, Jessica N. Cox

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Introduction: We describe a case of alemtuzumab (Campath®) hypersensitivity requiring desensitization within the medical intensive care unit (MICU) in a patient with T-cell prolymphocytic leukemia. Case report: We adopted a desensitization protocol from Gutierrez-Fernandez et al., which included three aliquots (0.15 mg intravenously (IV), 1.5 mg IV, and 28.5 mg IV) given approximately 1 h apart on day 1 followed by a full 30 mg dose IV on day 3. Unlike prior attempts to administer alemtuzumab to this patient, she tolerated the medication well and did not require any rescue medications. Management and outcome: Successful plan development required a significant amount of strategic communication between hematology/oncology and MICU-related physicians, pharmacists, and nurses to ensure a safe and effective desensitization. The first step of planning required creation of a desensitization order set with directions for medication preparation and administration, premedications, and available medications in the event of an adverse reaction or anaphylaxis. Anaphylactoid-related medications were prepared at bedside and ready for administration prior to beginning the desensitization. Alemtuzumab was compounded in a chemotherapy-certified hood and verified by at least two chemotherapy-certified pharmacists. Foreword planning was also necessary to ensure multiple people were available or present at bedside for the desensitization, including a chemotherapy-certified nurse, a second chemotherapy-certified nurse for verification, a critical care-certified pharmacist, a pulmonary/critical care attending physician, and hematology attending physician. Discussion: This case exemplifies the importance of clear and coordinated communication between different healthcare fields to safely and effectively complete extensive protocols such as desensitization strategies.

Original languageEnglish
Pages (from-to)742-746
Number of pages5
JournalJournal of Oncology Pharmacy Practice
Volume26
Issue number3
DOIs
StatePublished - Apr 1 2020

Keywords

  • Desensitization
  • alemtuzumab
  • hypersensitivity
  • intensive care unit
  • prolymphocytic leukemia

ASJC Scopus subject areas

  • Oncology
  • Pharmacology (medical)

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