Monoclonal Antibodies Infusion Reactions: Etiology, Prediction and Management by Nurse Practitioners
Marshall, Lynette V.
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Monoclonal antibodies have an increased risk of infusion reaction. Factors in the etiology of infusion reactions include percentage of mouse protein; immune response and cytokine release. Reactions typically occur with the initial infusion and in the presence higher tumor burdens. Predictive factors of infusion reactions include prior first infusions, increased amounts of lymphocytes, geographical region and rapid infusions. Management of reactions includes consideration of a test dose, premedication, supportive care and treatment alternatives of fully humanized monoclonal antibodies. Additional management options include desensitization protocols, as well as standing orders and crash cart availability. To improve patient safety, an emphasis is needed on staff education and the development of a process to evaluate and identify patients at risk. Standardized clinical pathways, policies and procedures need to be well rehearsed by staff to reduce negative consequences of infusion reactions. More research is needed on the identification of risk factors, as well as a clearer understanding of the mechanism of a monoclonal antibody infusion reaction. Monetary implications and hospitalizations are important to further determine the direct cost of infusion reactions of monoclonal antibodies.