Prolonged methylprednisolone premedication prior to obinutuzumab in patients with chronic lymphocytic leukemia
Prolonged methylprednisolone premedication prior to obinutuzumab in patients with chronic lymphocytic leukemia
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DOI：
10.1080/10428194.2019.1702182
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发表时间：
2019-12-14
影响因子：
2.6
通讯作者：
Mitrovic, Zdravko
中科院分区：
文献类型：
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作者：
Pejsa, Vlatko;Lucijanic, Marko;Mitrovic, Zdravko
首先，obinutuzumab应用与输注相关反应（IRR）相关，这可能会阻碍药物的进一步继续。在我们的临床实践中，我们观察到接受皮质类固醇的慢性淋巴细胞白血病（CLL）自身免疫性溶血性贫血（AIHA）患者不会发生obinutuzumab IRR。因此，我们决定对所有进一步的obinutuzumab候选者应用剂量为1-1.5 mg/kg的甲基强的松龙的延长的皮质类固醇前驱用药>= 7天。在这里，我们提出了28个连续的非随机比较先前未经治疗的CLL患者接受长期的皮质类固醇前驱用药（15例患者）或标准前驱用药（13例患者）之前，第一次obinutuzumab输注。延长皮质类固醇前驱用药导致所有级别（20% vs 61.5%; p = 0.025）和III级（0% vs 23.1%; p = 0.049）obinutuzumab IRR显著降低。延长皮质类固醇术前用药时间对感染并发症的发生没有显著影响。接受obinutuzumab的CLL和AIHA患者显示血红蛋白水平持续稳定增加，同时溶血参数降低。
First obinutuzumab application is associated with infusion related reactions (IRRs) that may discourage further continuation of the drug. During our clinical practice we have observed that chronic lymphocytic leukemia (CLL) patients with autoimmune hemolytic anemia (AIHA) prolongedly receiving corticosteroids do not develop obinutuzumab IRRs. Therefore, we decided to apply prolonged corticosteroid premedication with methylprednisolone in dose 1-1.5 mg/kg for >= 7 days to all further obinutuzumab candidates. Here we present non-randomized comparison of 28 consecutive previously untreated CLL patients receiving prolonged corticosteroid premedication (15 patients) or standard premedication (13 patients) prior to the first obinutuzumab infusion. Prolonged corticosteroid premedication resulted in significant reduction of all-grade (20% vs 61.5%; p = .025) and grade III (0% vs 23.1%; p = .049) obinutuzumab IRRs. Prolonged corticosteroid premedication did not significantly affect occurrence of infective complications. Patients with CLL and AIHA receiving obinutuzumab showed continuous and stable increase in hemoglobin levels concomitantly with decrease in parameters of hemolysis.