Recommended premedication for IRRs in first-line CLL
The following premedications are recommended before GAZYVA (obinutuzumab) infusion begins to reduce the risk of infusion-related reactions 1
- Closely monitor patients during the entire infusion. Infusion reactions within 24 hours of receiving GAZYVA have occurred
a20 mg dexamethasone or 80 mg methylprednisolone.
Hydrocortisone is not recommended as it has not been effective in
reducing the rate of infusion reactions.
bIf a glucocorticoid-containing chemotherapy regimen is administered on the same day as GAZYVA, the glucocorticoid can be administered as an oral medication if given at least 1 hour prior to GAZYVA, in which case additional intravenous glucocorticoid as premedication is not required.
cEg, 50 mg diphenhydramine.
Premedication and close monitoring are recommended for all patients 1
- Patients with preexisting cardiac or pulmonary conditions are at a greater risk of experiencing more severe infusion reactions
- Hypotension may occur during GAZYVA intravenous infusions. Consider withholding antihypertensive treatments for 12 hours prior to and throughout each GAZYVA infusion and for the first hour after administration
- Patients with high tumor burden, high circulating absolute lymphocyte counts (greater than 25 x 109/L), or renal impairment are considered at risk of tumor lysis syndrome and should receive prophylaxis. Premedicate with antihyperuricemics (eg, allopurinol or rasburicase) and ensure adequate hydration prior to start of GAZYVA therapy. Continue prophylaxis prior to each subsequent GAZYVA infusion, as needed
- Patients with Grade 3 to 4 neutropenia lasting more than one week are strongly recommended to receive antimicrobial prophylaxis until resolution of neutropenia to Grade 1 or 2. Consider antiviral and antifungal prophylaxis for patients with severe and long lasting (> 1 week) neutropenia.