Abstract
While mogamulizumab is a promising treatment for adult T-cell leukemia-lymphoma (ATLL), premedication must be administered to combat the infusion reactions (IR) that frequently develop. However, the actual standard premedication is insufficient to prevent IR. We therefore performed a retrospective case series to evaluate the modified premedication regimen suggested by our medical team for the prevention of IR with mogamulizumab therapy.
Despite standard premedication with hydrocortisone succinate, d-chlorpheniramine maleate, and acetaminophen, our first patient who had acute-type ATLL and received the first administration of mogamulizumab as fourth-line chemotherapy developed severe IR. We stopped the infusion and immediately administered methylprednisolone (125 mg, intravenous injection [iv]), oxygen inhalation, nitroglycerin (5 mg/h, intravenous drip infusion [div]), and loxoprofen (60 mg, per os [po]), which ameliorated IR after an hour. We administered a second dose of mogamulizumab to the patient after formulating a modified premedication regimen of dexamethasone (9.9 mg, iv), d-chlorpheniramine maleate (5 mg, iv), loxoprofen (60 mg, po), and a 12-h infusion of mogamulizumab. As a result, no IR occurred, and the patient received a total of seven infusions of mogamulizumab without any subsequent IR. We then administered this modified regimen to another seven patients from the initial cycle respectively, one of whom developed IR. This frequency of one in seven was lower than that noted in previous reports, suggesting that this modified premedication regimen was useful in preventing mogamulizumab-associated IR.
