부산대학교 도서관

Background: Obinutuzumab, an anti-CD20 monoclonal antibody, is indicated for the treatment of chronic lymphocytic leukaemia (CLL) and follicular lymphoma (FL). In CLL it is administered initially at a fixed rate and then at increasing variable rates with subsequent infusions as highlighted in Table 1.1 In FL rapid infusion over 90 min is licensed if no Grade 3 infusion-related reaction (IRR) occurred during cycle 1.1 The CLL11 trial demonstrated the highest risk of IRR in CLL patients occurred with the first 1000 mg obinutuzumab dose (65% all grades) and decreases significantly with second (3% Grades 1 and 2) and third or subsequent doses (1% Grades 1 and 2).1 This supports the tolerability of rapid infusion in CLL from cycle 2 (i.e. following four infusions). At our centre rapid infusion was introduced from cycle 2 for CLL in the absence of an IRR to the preceding dose in order to alleviate daycare capacity pressure, reduce chair time and improve the patient experience. Aim/objective: To retrospectively evaluate the safety and incidence of IRRs with Obinutuzumab rapid infusion in CLL patients at our centre over an 18-month period. Method: Retrospective data were collected from our electronic prescribing system and medical notes. CLL patients who completed a minimum of two cycles of obinutuzumab from December 2020 to May 2022 were identified. Infusion rate and IRR incidence were recorded from the medical notes and infusion proformas. IRR was graded using Common Terminology Criteria for Adverse Events Version 52 and verified by a clinician independently. Results/discussion: Eighteen patients completed a minimum of two cycles of Obinutuzumab during our audit period. Following the first 100 mg infusion, four patients (22%) had a Grade 3 IRR, 13 patients (72%) had a Grade 1-2 IRR, and one patient had no IRR. With subsequent infusions, only one Grade 1 IRR occurred with the second (900 mg) and third (1000 mg) infusions, and none with the fourth infusion (1000 mg). Hence, all 18 patients were eligible for rapid infusion from cycle 2. A total of 75 subsequent infusions were administered during the audit period, of which 49 were given at a rapid rate with the remainder at a standard rate. No IRRs were observed in those who received rapid infusion. One limitation of this audit was that rapid infusion was inconsistently administered from cycle 2 due to poor nursing awareness of this protocol. Conclusion: As a pilot in a single centre, rapid infusion of obinutuzumab can be administered safely in CLL patients from Cycle 2 in the absence of an IRR to the preceding dose. Our findings suggest that rapid infusion could be commenced earlier in the treatment protocol based on the low incidence of IRRs observed following the initial infusion. Increasing nursing awareness of the rapid infusion protocol is essential to optimise uptake and benefits. With wider adoption of rapid infusion in this setting, a multi-centre audit would be beneficial to consolidate the findings from this audit. This is also important if patients are receiving their first cycle in larger centres with subsequent infusions given at local centres. [ABSTRACT FROM AUTHOR]