II. Indications

  1. Hairy Cell Leukemia
    1. Moxetumomab pasudotox-tdfk
  2. B Cell precursor Acute Lymphoblastic Leukemia
    1. Inotuzumab Ozogamicin

III. Mechanism

  1. CD22
    1. CD22 is a B Cell lectin and adhesion molecule
    2. CD22 is involved in cell signaling and adhesion to Monocytes and T-Cells
  2. CD22 Monoclonal Antibody
    1. Conjugate antibodies that deliver cytotoxic drugs to CD22 positive cancer cells

IV. Medications

  1. Moxetumomab pasudotox-tdfk (Lumoxiti)
    1. Conjugated Monoclonal Antibody that delivers the cytotoxic drug Pseudomonas exotoxin A to cancer cells
    2. Avoid in severe Renal Insufficiency (eGFR <30 ml/min)
    3. Used in Hairy Cell Leukemia
    4. Risks of Hemolytic Uremic Syndrome, capillary leak syndrome, Nephrotoxicity, Electrolyte abnormalities
  2. Inotuzumab Ozogamicin (Besponsa)
    1. Conjugated Monoclonal Antibody that delivers the cytotoxic drug calicheamicin to cancer cells
    2. Used against B Cell precursors in Acute Lymphoblastic Leukemia
    3. Risks of hepatotoxicity and hepatic veno-occlusive disease

V. Dosing

  1. See other references for disease specific dosing protocols

VI. Adverse Effects: Moxetumomab

  1. Hemolytic Uremic Syndrome
  2. Capillary leak syndrome
  3. Nephrotoxicity
    1. Obtain Renal Function testing before each dose
  4. Infusion Reaction
    1. Premedicate
  5. Electrolyte abnormalities
    1. Obtain Electrolytes before each dose and at 8 days after dose
  6. Other common adverse effects
    1. Gastrointestinal (Nausea, Diarrhea, Constipation)
    2. Headache
    3. Fever
    4. Anemia

VII. Adverse Effects: Inotuzumab

  1. Infusion Reactions
  2. QTc Prolongation
  3. Hepatotoxicity
    1. Includes hepatic veno-occlusive disease (sinusoidal obstruction)
    2. Increased transaminases, GGT, and Serum Bilirubin
  4. Myelosuppression
    1. Thrombocytopenia
    2. Leukopenia
    3. Neutropenia
    4. Anemia
  5. Other common adverse effects
    1. Fever
    2. Nausea or Vomiting

VIII. Safety

  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters, Unknown Pregnancy category)
    1. Use reliable Contraception
  3. Monitoring
    1. Renal Function tests
    2. Serum Electrolytes (including Serum Calcium, Serum Phosphorus)
    3. Liver Function Tests (LFTs)

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