BSH2020 PO-088-A as per Terminology Common Criteria for Adverse Events (Ver 5.0)[6]. charts and medical/nursing notes were reviewed. IRR events were graded protocol change and 17 Data was retrospectively collated frompatients treated between initial histaminic premedication was given priorto each infusion. deemed ineligible for rapidinfusion. Corticosteroid,anti had alymphocyte count >5x10 experienced agrade 3or4IRR duringcycle 1, andpatients with CLL who infusionsfrom cycle 2 onwards (Figure 1,below).Patients who Eligible patients treated with obinutuzumabfor FL and CLLreceived rapid adopted 90 a The NorfolkUniversityand Norwich Hospital (NNUH)haematology unit infusion protocol. We reporthere initialour real Based on this evidence,[4,5]. ourdepartment hasimplemented rapid a onwards inselected patient groups, withno severe IRR events reported administration of1gobinutuzumab in90 R incurring significant and three rate changes, duration is be given with a faster rate incrementation, though minutes forIn the 1g[3]. absence of significant IRR, subsequent requires slowrate incrementation, with a T recorded and [1,2]. (FL) clinical practice Obinutuzumab isatype II monoclonal 9. 8. 2020;7(5):e370 7. 6. 5. 2018;48(8):736 4. 3. 2. 1. 1 J. Cunningham Adoption of Rapid Obinutuzumab Infusions: Real WorldInfusions: Obinutuzumabof Rapid AdoptionExperience he obinutuzumabmonograph ecent publications fromthe GATS and GATHER studies demonstrate safe Canales M et al et M Canales Lassalle Aal. et M Mateos Institute.Cancer National JPSharman al et al et K Ohmachi Medicines.org.uk. al. R et Marcus al. V et Goede Department of Haematology, Norfolk & Norwich University Hospitals Foundation Trust, United Kingdom 100mg/hr every minutes 30 (max400mg/hr) 100mg/hr every minutes 30 (max400mg/hr) 100mg/hr every minutes 30 (max400mg/hr) 100mg/hr 50mg/hr every minutes 30 (max400mg/hr) 50mg/hr Commence atCommence 100mg/hr,incrementing by atCommence 100mg/hr,incrementing by atCommence 100mg/hr,incrementing by (CLL Commence atCommence 50mg/hr,incrementing by FIGURE 1: FIGURE STANDARD INFUSION PROTOCOL – - daycomprises 1 100mg at 25mg/hour) V et al. et V – – duringtrials, at higher rates than with treatment [1,2]. 80. 42. Obinutuzumab plus Chlorambucil CLL with in 2014;370(12):1101Patients plus Chlorambucil Med. Engl J Obinutuzumab N Coexisting Conditions. and 195 minutes195 . Ongoing study of obinutuzumab short duration infection in patients with previously untreated advanced Follicular Follicular advanced Lymphoma. untreated previously with in patients infection duration short obinutuzumab of Ongoing study . Obinutuzumab for the First the for Obinutuzumab . Safety, tolerability and pharmacokinetics of shorter duration of infusion of obinutuzumab in Japanese patients with B with patients Japanese in obinutuzumab Safety,of infusion . of duration shorter of tolerability andpharmacokinetics Home administration of in is cost is in myelomamultiple bortezomib of Home administration . Obinutuzumab plus CHOP is effective and has a tolerable safety profile in previously untreated, advanced diffuseB advanced large untreated, previously in profile plus safetyCHOP tolerable Obinutuzumab effectivea andhas is . Subcutaneous versus intravenous daratumumab in patients with relapsed or refractory multiple myeloma (COLUMBA): a multicentre (COLUMBA): myelomamultiple refractory or relapsed with patients in daratumumab intravenous versus Subcutaneous - Gazyvaro 1,000 mg concentrate for solution for infusion. infusion. for solution for concentrate mg http://www.medicines.org.uk/emc/privacyAvailable1,000 Gazyvaro from: minute fixed for Joel Cunningham Lymphoma/CLL Common Common Toxicity Criteria 2017 VerHuman Services. Health and (CTCAE) of Events Adverse Department U.S. 5.0. the treatment of ChronicLymphocytic Leukaemia (CLL) chemotherapy chair time and nursing activity. 1 , D. Sparksman , th . These infusionsrequire imposinglengthy attendances on patients and BACKGROUND CYCLE 2 TREATMENTPROTOCOL January 2020. Demographic2020. January details, prescription - - rate infusion protocol from9th October 2018. Line Line TreatmentFollicular Lymphoma.of 2017;377(14):1331 Med. Engl J N METHODS CYCLE 1 CYCLE 1 CYCLE 1 9 /L at/L the commencement of cycle 2 were states that the first administration – DAY 1 (ONWARDS) I nfusion – – – anti DAY 15 DAY 8 DAY 1 100mg/hr every minutes 30 (max400mg/hr) 100mg/hr every minutes 30 (max400mg/hr) 100mg/hr 50mg/hr every minutes 30 (max400mg/hr) 50mg/hr Commence atCommence 100mg/hr,incrementing by atCommence 100mg/hr,incrementing by If no grade 3/4 IRR. (CLL, if lymphocytecountif <5x10 no gradeIf (CLL, 3/4 IRR. - Fixedrate minute 90 (666mg/hr) infusion Commence atCommence 50mg/hr,incrementing by minute infusionsfrom cycle 2 minimum infusion time of255 - (CLL CD20 - RAPID INFUSION PROTOCOL related reactions (IRRs) were 1 – , D. Gordon daycomprises 1 100mg at 25mg/hour) - - over three hoursper visit world experience. effective and is preferred by patients compared with hospital hospital withadm compared patients by is preferredeffective and antibody the minimum - pyretic and anti , nowused, in REFERENCES - Walker doses infusion can – 44. 9 - /L) 1 , A. Collins – 10. - policy - cell non cell rapid obinutuzumab infusionswere administered. incorrect utilisation ofstandard rate infusions.52 cycle patients2. 3 started in later cycles due to initial 12 patientscommenced (80%) rapid infusionsfrom Rapid infusion administration reactions duringinitial cycle 1 standard rate infusions. FL (Table patients 7 1). experienced (46%) grade 2 1 or with a youngerage range seen in patients treated for Patients received rapidinfusions for FL both and CLL, Pre therapy before cycle 2, and1was treated within trial). excluded dueto grade 3IRRs duringcycle ceased 1, 2 infusion.6 patients did notreceive rapid infusions(3 patients were suitable for rapid obinutuzumab between 21 patients received obinutuzumab protocols, similar to the widespread adoption ofrapid rituximab infusionprotocols several yearsago. advocate further discussionat a national level regarding the safe introduction of rapid obinutuzumab infusion GAZELLE study which willprovide further trial data on the tolerance of rapid obinutuzumab administration We [9]. We will continue to auditoutcomes fromour rapid obinutuzuambinfusion protocol. We alsoawait completion of the of recent innovative change in the provisionsystemic of anti important; subcutaneous daratumumab administration andhomebortezomib administration are other clear examples therapy uponourpatients. Novel techniques of administeringanti It is incumbent haematoupon received rapidly infusionsfrom cycle 2 onwards,with 3 grade only 1IRR events notedThe GATHER [4]. study included patients 70 who Authors oftheGATS study reported31 patients successfullywho received 90 nature of data collation. However, this data adds valuable real the need for repeated rate incrementation. This study is limited by patient small numbersand by the retrospective has saved over 91hoursof patient and chemotherapy chair time to date and hasreduced nursing acuity by eliminating patients had experiencedgrade IRR 1 or2 events duringthe first cycle of treatment. We estimate that this intervention onwards inselected patient groups.IRR No events were observed duringrapid infusions,even though almost half of The NNUHexperience suggests that fixed - and - cell cell - - Hem Hodgkin lymphoma: final results of the phase II GATS II phase the of results final lymphoma: Hodgkin study. Clin Oncol. J Jpn infusion characteristics - lega lymphoma : the phase II GATHER II the phase : lymphoma study. Lymphoma.Leuk 2019;60(4):894 inistration: results of a prospective single a prospective of results inistration: atol Oncol. 2019;37(S2):571 Oncol. atol l. [Accessed: 21.10.20] 21.10.20] [Accessed: l. 1 , o , , N. Shah , 9 pen th - October and2018 17 label, non label, - incremented minute 90 infusions,with 2 patientsonly experiencing mild (grade IRR 1/2) events [5]. - inferiority, Haematol. Lancet 3trial. phase randomised 1 – 2. - center study.center 2016;27(2):314 Oncol. Ann - oncology unitsto maximise resource utilisation andminimise the burdenanti of th - January 2020. 15 15 2020. January based treatment - rate minute90 obinutuzumabinfusions are well tolerated fromcycle two cohort, anestimated minimum 91hours of of treatment time was saved. Infusion duration wasshortened by approximately105 minutes. Inthis Resource outcomes started second line therapy and onepatient received palliative care). follow months, range 0 infusions).At the time of data evaluation (median followup duration of4 continue on therapy (3continue oninduction and2 on maintenance infection, and 2patients experienced recurrent infections). 5 patients treatment early due to other intolerance patient(1 passed away due to rapid 90 No patients experienced infusion related reactions of any grade during Patient outcomes DISCUSSION – 903 - up and2patients experienced disease progression(1 patient RESULTS - minute infusions.3 patients ceased obinutuzumab – 8 presented Table 1: Characteristics and outcomesfor patients receiving rapid infusions. Chlor, Chlorambucil. Prednisolone; CHOP,Cyclophosphamide O, Obinutuzumab;Benda,Bendamustine; CVP, Cyclophosphasmide priorto rapidinfusion (x10 IRRs cycleduring 1 (patients), Median no. ofrapidMedian infusions minuteinfusions completed IRRs rapidduring 90 Median lymphocyteMedian count Poster Poster Culmulative infusion time Total numberof rapid 90 Regimens used(patients) at time of datacollection - - bygrade reactionof Number ofpatients infusions (patients) Median ageMedian (years) cancer therapy inhaematology clinical practice [7,8]. 12 months), patients 7 remainedwatch on and wait Female (patients) - world experience to previouslyreported trial data. and implementation. and & Haematology, Oncology development protocol with assistance for Small, Matthew to thanks With saved (hours) @ at: W - cancer therapies are becoming ever @dr_jcunningham nnuh.nhs.uk/departments/haematology [email protected] - minute - minute fixed 9 - /L) 3 x O 1 x O 1 x grade 2 63 (38 2 x O - Vincristine 3 (1 47.25 Highly Specialist Pharmacist, NNUH Pharmacist, Specialist Highly 27 FL - - 0 2 6 - Benda CHOP - - - CVP - 8) rate obinutuzumab 81) - Doxorubicin 1 x grade 1, (0.24 5 x grade 2 9x O 78 (69 3 (1 43.75 0.69 CLL 25 - 0 6 9 - Chlor 1.33) - - 5) - 91) - more based - Prednisolone; - - department/ Vincristine 3 x O 1 x O 1 x grade 1, 6 x grade 2 9x O 74 (38 2 x O 3 (1 TOTAL - cancer 91 52 15 - - - 0 8 - Benda Chlor CHOP - - CVP - 8) 91) -