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Immunological reactions induced by bendamustine

机译：苯达莫司汀引起的免疫反应

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IntroductionBendamustine is being recently used as treatment ofchronic lymphocytic leukemia (CLL) and B-cell non-Hodgkin lymphoma. There are just a few reported casesof adverse reactions to bendamustine so far, none ofthem with an allergological study.MethodPatient 1A 61-year old woman, diagnosed with B-cell CLL (BCLL)received bendamustine, tolerating the first cycle.Three weeks later, 8 hours after the 1st dose of the 2ndcycle, she suffered throat discomfort, pruritus, hives,general erythema and facial swelling; which disappearedwithin 24 hours after treatment.Patient 2A 61-year old man, diagnosed with B-CLL. Four yearsago, he adequately tolerated bendamustine. One weekafter the first and well tolerated cycle, he received thesecond, and within 8-10 hours after the dose he developeda maculopapular exanthema, edema in arms andlegs, along with desquamation of hands and feet, withoutresidual lesions. Symptoms disappeared within thefirst two weeks.Patient 3A 63-year old man, diagnosed with B-CLL. Three hoursafter the infusion of the first and second cycles of bendamustine,he had a generalized tremor and fever of39℃. The symptoms ceased with acetaminophen650mg. One month later, 3 hours after the 3rd cycle ofbendamustine, he had generalized tremor and erythema,dizziness and body temperature of 39℃. Hypotension,paroxysmal atrial fibrillation and a mild renal failurewere verified. The symptoms disappeared with acetaminophen1gr and an adequate hydration.ResultsWe performed skin-prick-test (SPT) at 1 mg/ml andintradermal testing (IDT) at 0.001, 0.01, 0.1 and 1mg/ml, with immediate and delayed lectures (24h and 72h).As negative controls two B-CLL patients underwentSPT and IDT with negative results.Patient 1SPT was negative. IDT at 0.1 and 1mg/ml were positiveat 24h, being negative 72h later. The rest of the testswere negative.Patient 2He had a negative SPT. The 24h lectures of the IDTwere positive at 0.01, 0.1 and 1mg/ml, remaining positive72h later. The rest of the tests were negative.Patient 3The SPT and IDT, both immediate and delayed lectures,were negative.ConclusionWe report the first two cases of hypersensitivity tobendamustine with a positive result in the allergologicalstudy carried out, which demonstrated a delayed cutaneoushypersensitivity to bendamustine. We also reportthe first case of drug fever induced by bendamustine inclinical use, showing neither a type I nor a IV hypersensitivitymechanism to bendamustine.
机译：简介苯达莫司汀最近被用于治疗慢性淋巴细胞性白血病（CLL）和B细胞非霍奇金淋巴瘤。到目前为止，仅报道了少数对苯达莫司汀不良反应的病例，均未进行过敏性研究。方法患者1A，61岁，诊断为B细胞CLL（BCLL）的女性接受苯达莫司汀治疗，并耐受第一个周期。三周后，在第二个周期的第一个剂量后8小时，她遭受了喉咙不适，瘙痒，荨麻疹，一般性红斑和面部肿胀;患者在治疗后24小时内消失。患者2A 61岁，被诊断为B-CLL。四年前，他充分耐受苯达莫司汀。在第一个耐受良好的周期后第一个星期，他接受了第二个周期，并且在给药后的8-10小时内出现了斑丘疹性皮疹，手臂和腿部浮肿以及手脚脱皮，没有残留病变。症状在头两周内消失。3A患者63岁，被诊断为B-CLL。输注苯达莫司汀的第一个和第二个周期后三个小时，他的全身震颤和发烧为39℃。对乙酰氨基酚650mg症状消失。一个月后，苯达莫司汀的第三个周期后3个小时，他出现了全身性震颤和红斑，头晕和体温39℃。证实低血压，阵发性心房颤动和轻度肾功能衰竭。结果通过对乙酰氨基酚和足够的水分补充后症状消失了。结果我们分别进行了1 mg / ml的皮肤点刺试验（SPT）和0.001、0.01、0.1和1mg / ml的皮内试验（IDT），并立即进行了授课和延迟授课（24h和72h）作为阴性对照，两名B-CLL患者接受了SPT和IDT治疗，结果均为阴性，患者1SPT阴性。 0.1和1mg / ml的IDT在24小时呈阳性，而在72小时后呈阴性。其余测试均为阴性。患者2他的SPT为阴性。 IDT的24小时讲座分别以0.01、0.1和1mg / ml呈阳性，72小时后保持阳性。患者3的SPT和IDT，无论是立即授课还是延迟授课，均为阴性。结论我们在头两例对苯达莫司汀过敏的病例中报告了阳性结果，表明对苯达莫司汀的皮肤过敏反应有所延迟。我们还报告了第一例因苯达莫司汀临床使用引起的药物热，未显示出对苯达莫司汀的I型或IV型超敏机制。

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