Desensitization of Immunomodulating Agent–Related Hypersensitivity Reactions as a Means to Provide Therapeutic Options in the Management of Plasma Cell Disorders (DeHyperPCD)

Hypersensitivity reactions (HSRs) can be a significant barrier to a patient’s cancer treatment journey. HSRs caused by immunomodulating agents, specifically lenalidomide (LEN) can be overwhelmingly distressful, paradoxically depriving patients of access to a clinically meaningful drug. Based on our historical clinical experiences, we have learned that the rapid desensitization protocol (RDP), when executed precisely, can enable patients to successfully resume LEN treatment. This served as the impetus for initiating our prospective study. We consecutively enrolled 10 patients diagnosed with plasma cell disease who had experienced a previous HSR specifically with LEN. After fully recovering from their initial reactions, patients underwent a controlled 10–12 steps incremental increase in drug dosage administration, followed by daily resumption of LEN over a 90‐day period. All 10 (100%) patients successfully completed the protocol and continued on further LEN treatment cycles, although 1 patient voluntarily chose to withdraw from the study due to recurrent symptoms after receiving 2 doses of LEN. Three (30%) patients remained symptom‐free throughout the follow‐up period. Six (60%) patients experienced mild and short‐lived HSR reactivation; however, all had the ability to take LEN for the majority of the study period. RDP enables patients to continue taking LEN and maintains the health‐related quality of life (HR‐QoL) by reducing the occurrence of HSR. RDP empowers patients to participate in future clinical trialsinvolving novel treatments that contain LEN as a backbone therapy, opportunities they would have otherwise been ineligible for.