BNF for Children 2011-2012

BNFC 2011–2012 8.2.4 Other immunomodulating drugs 439Alemtuzumab, another monoclonal antibody thatcauses lysis of B and T lymphocytes, has been used inchildren for conditioning therapy before allogeneic bonemarrow transplantation. In common with rituximab, itcauses infusion-related side-effects including cytokinerelease syndrome (see above) and premedication withparacetamol, an antihistamine, and a corticosteroid isrecommended.ALEMTUZUMABCautions see notes above—for full details (includingmonitoring) consult product literature or local treatmentprotocolContra-indications for full details consult product literatureor local treatment protocolPregnancy avoid; manufacturer advises effectivecontraception during and for 6 months after treatmentin men or womenBreast-feeding manufacturer advises avoid breastfeedingduring treatment and for at least 4 weeks aftertreatmentSide-effects see notes above—for full details (includingmonitoring and management of side-effects)consult product literatureLicensed use not licensed for use in children under17 yearsIndication and doseSee notes above. By intravenous infusionConsult local treatment protocol for details8.2.4 Other immunomodulatingdrugsInterferon alfaInterferon alfa has shown some antitumour effect andmay have a role in inducing early regression of lifethreateningcorticosteroid-resistant haemangiomas ofinfancy. Interferon alfa preparations are also used inthe treatment of chronic hepatitis B, and chronic hepatitisC ideally in combination with ribavirin (section5.3.3). Interferon alfa should always be used under theclose supervision of a specialist. Side-effects are doserelated,but commonly include anorexia, nausea, influenza-likesymptoms, and lethargy. Ocular side-effectsand depression (including suicidal behaviour) have alsobeen reported. Myelosuppression may occur, particularlyaffecting granulocyte counts. Cardiovascular problems(hypotension, hypertension, and arrhythmias),nephrotoxicity and hepatotoxicity have been reportedand monitoring of hepatic function is recommended.Hypertriglyceridaemia, sometimes severe, has beenobserved; monitoring of lipid concentration is recommended.Other side-effects include hypersensitivityreactions, thyroid abnormalities, hyperglycaemia, alopecia,psoriasiform rash, confusion, coma and seizures,and reversible motor problems in young children.Rarely pulmonary infiltrates, pneumonitis, and pneumoniahave occurred; respiratory symptoms should beinvestigated and if pulmonary infiltrates are suspectedor lung function is impaired the discontinuation ofinterferon alfa should be considered.MabCampath c (Genzyme) AConcentrate for intravenous infusion, alemtuzumab30 mg/mL, net price 1-mL amp = £264.11RITUXIMABCautions see notes above—but for full details(including monitoring) consult product literature orlocal treatment protocolPregnancy avoid unless potential benefit to motheroutweighs risk of B-lymphocyte depletion in fetus—effective contraception (in both sexes) required duringand for 12 months after treatmentBreast-feeding avoid breast-feeding during and for 12months after treatmentSide-effects see notes above—but for full details(including monitoring and management of sideeffects)consult product literatureLicensed use not licensed for use in childrenIndication and doseSee notes above. By intravenous infusionConsult local treatment protocol for detailsMabThera c (Roche) AConcentrate for intravenous infusion, rituximab10 mg/mL, net price 10-mL vial = £174.63, 50-mL vial= £873.15INTERFERON ALFACautions consult product literature and local treatmentprotocol for details; interactions: Appendix 1(interferons)Contra-indications consult product literature andlocal treatment protocol for details; avoid injectionscontaining benzyl alcohol in neonates (see underpreparations below)Hepatic impairment close monitoring in mild tomoderate impairment; avoid if severeRenal impairment close monitoring required in mildto moderate impairment; avoid in severe impairmentPregnancy avoid unless potential benefit outweighsrisk (toxicity in animal studies); effective contraceptionrequired during treatment—consult productliteratureBreast-feeding unlikely to be harmfulSide-effects see notes above, consult product literatureand local treatment protocols for detailsLicensed use not licensed for use in children forchronic active hepatitis B; Roferon-A c not licensedfor use in childrenIndication and doseInduction of early regression of life-threateningcorticosteroid resistant haemangiomata ofinfancy. By subcutaneous injectionConsult local treatment protocol for detailsChronic active hepatitis B infection see underpreparations below8 Malignant disease and immunosuppression