Novel Protocol for Rapid Desensitization of Melphalan in a ۵-Year-Old Boy Undergoing Conditioning for Hematopoietic Stem Cell Transplantation: A Case Report

Hematopoietic stem cell transplantation is a potentially life-saving therapy under certain conditions. Hypersensitivity reaction to chemotherapeutic drugs may interfere with this treatment. Griscelli syndrome type ۲ is a rare autosomal recessive disease characterized by hypopigmentation of skin and hair, causing silver gray hair; this disease may develop a fatal condition called hemophagocytic lymphohistiocytosi. The main curative treatment for hemophagocytic lymphohistiocytosi is hematopoietic stem cell transplantation. Melphalan is an important drug in hematopoietic stem cell transplantation preparation regimen. This drug is only stable for ۶۰ minutes following reconstitution with normal saline. There is a recommended ۱۲- to ۲۰-step desensitization protocol for moderate to severe hypersensitivity reaction to chemotherapeutic drugs. However, due to the short term stability of melphalan, this protocol cannot be employed in desensitization. In this case report, we presented a novel protocol for rapid desensitization of melphalan in a ۵-year-old boy with immediate, moderate to severe hypersensitivity reaction, during hematopoietic stem cell transplantation. To obtain ۵۰ mg total melphalan , we prepared solutions of drug in two bags; one with ۱۲.۵mg in ۳۵ cc normal saline, and other with ۲۵ mg in ۳۵ cc normal saline. Each solution was infused during ۶۰ minutes by incremental infusion rate, and the total of ۵۰ mg melphalan was successfully infused.

کلیدواژه ها:

Rapid desensitization ، Melphalan ، Hematopoietic stem cell transplantation ، Child