Background and importance A 65-year-old woman with Philadelphia chromosome positive acute lymphoblastic leukaemia was treated with dasatinib 140 mg daily. After the first dose, the patient experienced anaphylactic shock presenting poor general condition, nausea, rash, diarrhoea, severe hypotension, anuria and angioedema. Dasanitib treatment was discontinued and corticosteroid and fluid therapy were initiated. The allergy was not confirmed by skin testing as the reaction was very recent and it was considered essential to start a dasatinib desensitisation protocol immediately.
Aim and objectives To report the successful oral desensitisation protocol for dasatinib.
Material and methods The available literature was reviewed and the following oral desensitisation protocol was designed to reach the therapeutic daily dose of 140 mg. Day 1: a tablet of dasatinib 20 mg was crushed, dissolved and diluted in water to prepare six solutions: 20 ng/mL (A), 200 ng/mL (B), 2 μg/mL (C), 20 μg/mL (D), 200 μg/mL (E) and 2 mg/mL (F). It was administered as nine increasing dasatinib doses at 30 min intervals: 1 mL of solutions A–E followed by 1 mL, 2 mL, 3 mL and 4 mL of solution F. In the following days: from tablets, consecutively each day, one of these increasing doses was given 20 mg, 40 mg, 70 mg, 90 mg, 110 mg and 140 mg.
Results When the patient took the 90 mg dose she experienced pruritic malar oedema, neck erythema and abdominal hives. She was administered antihistamines and corticosteroids. The protocol was restarted after 48 hours at the 70 mg dose, with premedication. Some hours later, the patient experienced rash in the upper left limb and facial oedema. The next day the scheme was begun at 40 mg. It was followed by 70 mg, 90 mg (divided into two daily doses of 70 mg and 20 mg), 110 mg (divided into 70 mg and 40 mg) and reached 140 mg (70 mg twice a day). It has been well tolerated for 7 weeks.
Conclusion and relevance This was a successful dasatinib desensitisation protocol. The use of a desensitisation protocol enables patients with hypersensitivity reactions to the drug to be treated safely with the most convenient therapy.
References and/or acknowledgements 1. Karaatmaca B, et al. Successful oral desensitisation with dasatinib in delayed cutaneous hypersensitivity reactions. Ann Allergy Asthma Immunol 2019;1–2.
No conflict of interest.
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