Desensitization to imatinib in patients with leukemia

Robert Nelson, Kenneth Cornetta, Kelly E. Ward, Srinivasan Ramanuja, Chris Fausel, Larry Cripe

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Imatinib mesylate is a tyrosine kinase inhibitor used for the treatment of chronic myeloid leukemia and hypereosinophilic syndrome. Imatinib is associated with a variety of adverse cutaneous reactions, including urticaria, maculopapular exanthem, generalized exanthematous pustulosis, exfoliative dermatitis, and Stevens-Johnson syndrome. Objective: To evaluate the safety and efficacy of oral desensitization by administering incremental dosages of imatinib mesylate to patients with leukemia who have had rashes associated with prior exposure. Methods: Ten patients with leukemia and imatinib-associated recurrent rash underwent a 4-hour outpatient oral desensitization procedure. Beginning with 10 ng, we administered oral imatinib elixir in increasing dosages every 15 minutes. Patient outcomes were monitored by a return clinic visit and by telephone follow-up for a median of approximately 3 years. Results: No episodes of anaphylaxis or serious adverse effects occurred during or immediately after desensitization. Four patients (all with urticaria) had no recurrence of rash after desensitization, and 4 had recurrent rash that resolved after temporary glucocorticosteroid and antihistamine administration. Two patients developed a recurrent rash 5 hours and several days after the procedure and were unable to resume therapy. Conclusion: This oral desensitization protocol appears to help some leukemic patients with recurrent rash tolerate imatinib mesylate, thus permitting continuation of this life-prolonging therapy. These findings suggest that some adverse cutaneous reactions to imatinib may be due to a hypersensitivity mechanism rather than a pharmacologic effect.

Original languageEnglish
Pages (from-to)216-222
Number of pages7
JournalAnnals of Allergy, Asthma and Immunology
Volume97
Issue number2
StatePublished - Aug 2006

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Exanthema
Leukemia
Urticaria
Hypereosinophilic Syndrome
Exfoliative Dermatitis
Drug Eruptions
Stevens-Johnson Syndrome
Skin
Histamine Antagonists
Anaphylaxis
Ambulatory Care
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Imatinib Mesylate
Telephone
Protein-Tyrosine Kinases
Hypersensitivity
Outpatients
Therapeutics
Safety
Recurrence

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

Desensitization to imatinib in patients with leukemia. / Nelson, Robert; Cornetta, Kenneth; Ward, Kelly E.; Ramanuja, Srinivasan; Fausel, Chris; Cripe, Larry.

In: Annals of Allergy, Asthma and Immunology, Vol. 97, No. 2, 08.2006, p. 216-222.

Research output: Contribution to journalArticle

Nelson, Robert ; Cornetta, Kenneth ; Ward, Kelly E. ; Ramanuja, Srinivasan ; Fausel, Chris ; Cripe, Larry. / Desensitization to imatinib in patients with leukemia. In: Annals of Allergy, Asthma and Immunology. 2006 ; Vol. 97, No. 2. pp. 216-222.
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