Prophylaxis Against Toxicity

Several premedications should be considered to minimize the likelihood and severity of infusion reactions and infectious complications. Although not seen with antibody therapy in patients with solid tumors or NHL, tumor lysis is an uncommon complication of antibody treatment in CLL patients. Allopurinol should be given for the first 7-10 d of therapy, and patients should increase oral fluid intake the night before treatment. All patients who have previously received fludarabine or who are being treated with Campath 1H should receive prophylaxis for PCP and VZV. We place our patients on Bactrim DS® twice daily MWF and acyclovir 400-800 mg three times daily, and we continue prophylaxis indefinitely in the absence of adverse effects. Patients undergoing antibody therapy for relapsed CLL are often immuno-compromised, owing to hypogammaglobulinemia and prior immunosuppressive therapy. To minimize the likelihood and severity of infusion toxicity, Tylenol® (650 mg), Benadryl® (50 mg iv), and a potent antiemetic (granisetron or ondansetron) are given approx 30 min prior to starting the infusion.

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