Page 692 - Clinical Immunology_ Principles and Practice ( PDFDrive )

CHaPTEr 48 Drug Hypersensitivity 665

TABLE 48.6 Example of 12-Step Desensitization Protocol for Carboplatin
Target dose (mg) 300
Standard volume per bag (mL) 250
Final rate of infusion (mL/h) 80
Calculated target concentration (mg/mL) 1.2
Standard time of infusion (minutes) 187.5
Concentration amount
volume (mg/mL) Total mg per Bag infused (mL)
Solution 1 250 mL of 0.012 mg/mL 3 9.38
Solution 2 250 mL of 0.120 mg/mL 30 18.75
Solution 3 250 mL of 1.190 mg/mL 297.638 250
***NB*** The total volume and dose dispensed are more than the final dose given to patient because many of the
solutions are not completely infused.
volume infused Dose administered Cumulative
Step Solution rate (mL/h) Time (min) Per Step (mL) With This Step (mg) Dose (mg)
1 1 2.5 15 0.63 0.0075 0.0075
2 1 5 15 1.25 0.015 0.0225
3 1 10 15 2.5 0.03 0.0525
4 1 20 15 5 0.06 0.1125
5 2 5 15 1.25 0.15 0.2625
6 2 10 15 2.5 0.3 0.5625
7 2 20 15 5 0.6 1.1625
8 2 40 15 10 1.2 2.3625
9 3 10 15 2.5 2.98 5.3389
10 3 20 15 5 5.95 11.2916
11 3 40 15 10 11.91 23.1971
12 3 80 174.375 232.5 276.8 300
Total time: 5.66 hours

TABLE 48.7 Example of a Four-Bag 16-Step High-risk Desensitization to Ofatuzumab
Bag volume per Bag (mL) Concentration (mg/mL) Total Dose per Bag (mg) amount of Bag infused (mL)
1 250 0.002 0.500 9.38
2 250 0.040 10.000 9.38
3 250 0.400 100.000 18.75
4 250 3.968 992.106 250.00
**NB** The total volume and dose dispensed are more than the final dose given to patient because many of the solutions are not completely
infused.
volume Dose
Cumulative infused per administered With Cumulative Fold increase
Step Bag rate (mL/h) Time (min) Time(min) Step(mL) This Step (mg) Dose (mg) per Step
1 1 2.5 15 15 0.625 0.001 0.001
2 1 5 15 30 1.25 0.003 0.004 2
3 1 10 15 45 2.5 0.005 0.009 2
4 1 20 15 60 5 0.010 0.019 2
5 2 2.5 15 75 0.625 0.025 0.044 2.5
6 2 5 15 90 1.25 0.050 0.094 2
7 2 10 15 105 2.5 0.100 0.194 2
8 2 20 15 120 5 0.200 0.394 2
9 3 5 15 135 1.25 0.500 0.894 2.5
10 3 10 15 150 2.5 1.000 1.894 2
11 3 20 15 165 5 2.000 3.894 2
12 3 40 15 180 10 4.000 7.894 2
13 4 10 15 195 2.5 9.921 17.815 2.5
14 4 20 15 210 5 19.842 37.657 2
15 4 40 15 225 10 39.684 77.341 2
16 4 80 174.375 399.375 232,5 922.659 1,000.000
Total infusion time: 6.6 hours
Standard volume per bag: 250 mL
Final rate of infusion: 80 mL/h (as patient now deemed tolerant)
Number of bags: 4; time per step: 15 minutes; total number of steps: 16; total dose: 1000 mg.