A 55-year-old male diagnosed in 2006 with CLL who received immunochemotherapy in 2008 with Rituximab-Cicific Lopezil-Fludarab achieved a partial response.
In 2011, disease progression was evident and a second-line treatment was started with Rituximab 375mg/m2 day 1 of the cycle and Bendamustine 90 mg/m2 days 1 and 2 every 28 days.
Four hours after the administration of day 1 of the second immunochemotherapy cycle, the patient came to the emergency room presenting dysthermic sensation, fever of 38oC and urticariform reaction with pruritus and erythrodermy.
Skin tests with bendamustine were performed due to the possibility of an allergic reaction to this cytokine.
The mother solution used bendamustine 2.5mg/ml, performing dilutions 1/10, 1/100, 1/1000 and 1/100 for intradermal administration.
Given the good tolerance prior to rituximab for 6 cycles, the skin reaction to bendamustine was associated.
Toxicodermia was classified as grade 4 according to the Common Toxicity Criteria (version 4.0)9 and notified by the card to the Spanish Personality System.
Skin tests performed were negative for all dilutions.
However, after the benefit/risk assessment between the severity of the drug eruption and the potential benefit of bendamustine treatment, it was decided to develop a PD for the administration of the following bendamustine cycles.
The PD consisted of 12 steps for the administration of the total dose of the drug (186.3mg).
The protocol consisted of progressively increasing the infusion rate and drug concentration until reaching the total therapeutic dose.
Three solutions were prepared A, B, and C of the dilutions 1/100, 1/10 and 1/1 respectively.
Each solution was used for four steps, increasing the infusion rate every 15 minutes, so that with each step it was administered twice as much as in the previous step.
In the last step, the rate was kept constant until completing the administration of the total dose defined.
Table 1 summarizes the solutions and scheme for administering the dressing regimen.
1.
The administration was performed in the Hematology ward under medical supervision, with a total duration of 5 hours and 37 minutes.
The patient received 6 cycles of immunochemotherapy with bendamustine by PD with mild cutaneous pruritus but without serious complications.
