Standardizing isatuximab infusion rates using a fixed dilution ­concentration: A quality improvement initiative to reduce workload and maintain safety in clinical practice

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Background: Isatuximab requires careful infusion rate control to mitigate infusion-related reactions (IRRs). In real-world practice, complex infusion preparation and rate calculations increase healthcare providers’ workload and may lead to medication order errors. We evaluated whether standardizing isatuximab dilution could simplify administration while maintaining safety.

Methods: This retrospective quality improvement study included 44 patients with multiple myeloma treated with isatuximab at two institutions between October 2020 and October 2023. Fourteen patients received conventional weight-based dilution, while 30 received a fixed-dilution protocol (2 mg/mL) with a standardized infusion rate. The primary outcome was medication order revisions; secondary outcomes were IRR incidence and severity.

Results: Sixty order revisions occurred in the conventional group, whereas none occurred in the fixed-dilution group. The incidence of IRRs (28.6% vs. 43.3%, p = 0.509) and grade ≥3 IRRs (7.1% vs. 3.3%, p = 0.540) did not differ significantly.

Conclusions: Standardizing isatuximab dilution simplified infusion procedures, eliminated order revisions, and maintained patient safety. This pragmatic approach provides real-world evidence that protocol standardization can reduce operational burden while preserving clinical safety in oncology practice.