Clinical Presentation and Management of a Dinutuximab Beta Extravasation in a Patient with Neuroblastoma

Abstract

Extravasation can present serious accidental complication of intravenous drug application. While monoclonal antibodies do not show the necrotic potential of cytotoxic chemotherapy drugs, considerable inflammatory toxicity can occur, necessitating standardized operating procedures for the management of their extravasation. Here, we report the clinical course and management of dinutuximab beta extravasation in a 3-year-old child. Dinutuximab beta is a chimeric monoclonal antibody targeting the GD2 disialoganglioside on the surface of neuroblastoma cells that has in recent years gained significant importance in the treatment of high-risk neuroblastoma, now contributing to both first- and second-line therapy protocols. The dinutuximab beta extravasation reported here occurred when the patient received the antibody cycle as a continuous infusion over a 10-day period after haploidentical stem cell transplantation for relapsed high-risk neuroblastoma. The extravasated dinutuximab beta caused local pain, swelling, and hyperemia accompanied by fever and an overall deterioration in the general condition. Laboratory diagnostics demonstrated an increase in C-reactive protein level and total white blood cell count. Clinical complication management consisted of intravenous fluid therapy, local dabbing with dimethyl sulfoxide (DMSO), analgesia with dipyrone, as well as application of intravenous antibiotics to prevent bacterial superinfection in the severely immunocompromised host. The patient considerably improved after six days with this treatment regimen and fully recovered by day 20.

Extravasation injury management for neonates and children: A systematic review and aggregated case series

“…First aid interventions, as shown in Figure 2a , were identified in 26 studies. 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 Stopping the IV and removal was the most common intervention, 16 , 17 , 18 , 19 , 22 , 23 , 25 , 26 , 28 , 29 , 30 , 31 , 34 , 35 followed by elevation 16 , 17 , 19 , 20 , 21 , 24 , 25 , 26 , 28 , 29 , 31 , 32 and compression. 17 , 27 , 29 , 31 ,…”

“…Medical interventions, as shown in Figure 2b , were identified in 18 studies, the most common being hyaluronidase, 18 , 21 , 29 , 31 , 35 , 36 , 37 with some studies using it in conjunction with the wash‐out technique to increase positive outcomes. Antibiotics, 19 , 24 , 26 , 27 , 37 honey, 34 , 37 , 38 , 39 collagenase, 24 , 30 , 37 , 38 and hyaluronic acid 18 were also utilized.…”

“…First aid interventions were primarily used in conjunction with medical, surgical, and dressing interventions. First aid interventions, as shown in Figure 2a, were identified in 26 studies 16–36 . Stopping the IV and removal was the most common intervention, 16–19,22,23,25,26,28–31,34,35 followed by elevation 16,17,19–21,24–26,28,29,31,32 and compression 17,27,29,31–33,36 …”

“…First aid interventions, as shown in Figure 2a, were identified in 26 studies. Stopping the IV and removal was the most common intervention, [16][17][18][19]22,23,25,26,[28][29][30][31]34,35 followed by elevation 16,17,[19][20][21][24][25][26]28,29,31,32 and compression. 17,27,29,[31][32][33]36 F I G U R E 1 Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review flow chart.…”

“…As shown in Table 3, 21 studies identified what was caused by the extravasation prior to treatment, [16][17][18][19][20][21][22][23]25,26,[31][32][33][34][35][36][37][39][40][41][42] which most commonly included swelling, [17][18][19]26,33,36,[40][41][42] blisters, 16,17,20,25,33,37,40,42 pain, 16,23,26,36,42 skin necrosis, 16,[20][21][22]25,[32][33][34]…”