[Castleman's disease: Rapid desensitization for hypersensitivity reaction to rituximab]

Abstract

Introduction: Rapid desensitization allows secure administration of a drug and is indicated when there is no therapeutic alternative.

Case report: We report a 49-year-old patient who presented with a hypersensitivity reaction following an infusion of rituximab (375mg/m(2)) in the context of a Castleman's syndrome. After a clinical flare (splenomegaly, adenopathies) despite treatment with tocilizumab, anakinra and valganciclovir, the reintroduction of rituximab was decided, according to the rapid desensitization protocol. Four full dose desensitizations were successfully performed allowing immediate clinical improvement (apyrexia, loss of sweating and lymphadenopathy, splenomegaly partial regression) and biological (negativation of HHV8 viral load, and disappearance of neutropenia, anemia and thrombocytopenia).

Conclusion: Rapid desensitization is a promising method for the pursuit of rituximab therapy after a hypersensitivity reaction and should be considered in patients with no acceptable therapeutic alternative.

Keywords: Anticorps monoclonaux; Desensitization; Désensibilisation; Hypersensitivity reaction; Monoclonal antibodies; Rituximab; Réaction d’hypersensibilité.