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.