Document Type : Case Report(s)
Authors
1 Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Childern Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Pediatrics, Division of Pediatric Allergy and Clinical Immunology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Pediatrics Hematology and Oncology, Thalassemia Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
Abstract
Hematopoietic stem cell transplantation is a potentially life-saving therapy under certain conditions. Hypersensitivity reaction to chemotherapeutic drugs may interfere with this treatment. Griscelli syndrome type 2 is a rare autosomal recessive disease characterized by hypopigmentation of skin and hair, causing silver gray hair; this disease may develop a fatal condition called hemophagocytic lymphohistiocytosi. The main curative treatment for hemophagocytic lymphohistiocytosi is hematopoietic stem cell transplantation. Melphalan is an important drug in hematopoietic stem cell transplantation preparation regimen. This drug is only stable for 60 minutes following reconstitution with normal saline. There is a recommended 12- to 20-step desensitization protocol for moderate to severe hypersensitivity reaction to chemotherapeutic drugs. However, due to the short term stability of melphalan, this protocol cannot be employed in desensitization. In this case report, we presented a novel protocol for rapid desensitization of melphalan in a 5-year-old boy with immediate, moderate to severe hypersensitivity reaction, during hematopoietic stem cell transplantation. To obtain 50 mg total melphalan , we prepared solutions of drug in two bags; one with 12.5mg in 35 cc normal saline, and other with 25 mg in 35 cc normal saline. Each solution was infused during 60 minutes by incremental infusion rate, and the total of 50 mg melphalan was successfully infused.
Keywords
How to cite this article:
Shamsian BS, Babaei D, Naderisorki M. Novel protocol for rapid desensitization of melphalan in a 5-year-old boy undergoing conditioning for hematopoietic stem cell transplantation: A case report. Middle East J Cancer. 2020;11(4): 503-6. doi: 10.30476/mejc.2020. 82356.1081.
- Griscelli C, Durandy A, Guy-Grand D, Daguillard F, Herzog C, Prunieras M. A syndrome associating partial albinism and immunodeficiency. Am J Med. 1978;65(4):691-702.
- Ménasché G, Pastural E, Feldmann J, Certain S, Ersoy F, Dupuis S, et al. Mutations in RAB27A cause Griscelli syndrome associated with haemophagocytic syndrome. Nat Genet. 2000;25(2):173-6.
- Henter JI, Horne A, Aricó M, Egeler RM, Filipovich AH, Imashuku S, et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer. 2007;48(2):124-31.
- Castells Guitart MC. Rapid drug desensitization for hypersensitivity reactions to chemotherapy and monoclonal antibodies in the 21st century. J Investig Allergol Clin Immunol. 2014;24(2):72-9; quiz 2 p following 79.
5- Bleichner F, Mende S. Allergic reaction to melphalan. [Article in German] Onkologie 1982;5:195. doi: 10.1159/000214999.
6- Cornwell GG 3rd, Pajak TF, McIntyre OR. Hypersensitivity reactions to iv melphalan during treatment of multiple myeloma: Cancer and Leukemia Group B experience. Cancer Treat Rep. 1979;63(3):399-403.
7- Schwartz LB. Diagnostic value of tryptase in anaphylaxis and mastocytosis. Immunol Allergy Clin North Am. 2006;26(3):451-63.
8- Mezzano V, Giavina-Bianchi P, Picard M, Caiado J, Castells M. Drug desensitization in the management of hypersensitivity reactions to monoclonal antibodies and hemotherapy. BioDrugs. 2014;28(2):133-44. doi: 10.1007/s40259-013-0066-x.
9- Macglashan D, Miura K. Loss of syk kinase during IgE-mediated stimulation of human basophils. J Allergy Clin Immunol. 2004;114(6):1317-24.
10- Gastaminza G, de la Borbolla JM, Goikoetxea MJ, Escudero R, Antón J, Espinós J, et al. A new rapid desensitization protocol for chemotherapy agents. J Investig Allergol Clin Immunol. 2011;21(2):108-12.
11- Castells MC, Tennant NM, Sloane DE, Hsu FI, Barrett NA, Hong DI, et al. Hypersensitivity reactions to chemotherapy: outcomes and safety of rapid desensitization in 413 cases. J Allergy Clin Immunol. 2008;122:574-80. doi: 10.1016/j.jaci.2008.02.044.
)