A practical 16-day Desensitization Protocol in Lenalidomide induced Non-immediate Hypersensitivity Reactions

Abstract Background Desensitization in immediate type hypersensitivity reactions (HRs) due to chemotherapeutics is well described and standardized for many drugs. However, there are no standardized protocols in non-immediate HRs. Objective Our aim is to evaluate the effectiveness of a 16-day desensitization protocol in the non-immediate HRs induced by lenalidomide. Methods According to our previously published slow desensitization protocol, we desensitized patients who had experienced non-immediate HRs due to lenalidomide. The protocol was started with the 1/100 of the daily-prescribed dose in milligrams of the culprit drug; then the doses were slowly increased in order to complete the procedure in 16 days. Demographic and clinical features of the patients were further appraised. Results Ten patients (mean age was 64.7±10.8 years, 7 male) were successfully desensitized to lenalidomide. The mean reaction time was 7.3±3.9 days in the history and the reaction types were delayed urticaria (n=4), eczematous rash (n=3) and maculopapular eruptions (n=3). The desensitization was successfully completed in 16 days in 9 patients. In 1 patient, maculopapular eruptions developed on the 11th day and the patient was treated with corticosteroids. We repeated the previous tolerated dose longer and completed with a slower dose increasement and the targeted dose was achieved in 35 days. Conclusion The 16-day desensitization protocol seemed to be safe and effective in the non-immediate type DHRs caused by lenalidomide.