Fatal hypersensitivity reaction to gemtuzumab ozogamicin associated with platelet transfusion

Abstract

A case of a fatal hypersensitivity reaction to gemtuzumab ozogamicin in a patient who received a platelet transfusion on the same day is presented. A 75-year-old man went to a hematology clinic in April 2005 because of anemia and thrombocytopenia. He was diagnosed with acute myelogenous leukemia (AML). In May 2005, the patient was started on induction chemotherapy with cytarabine and idarubicin. During the induction phase, the patient received platelet transfusions on multiple occasions without any evidence of transfusion reactions. He went into partial remission and received two cycles of cytarabine and idarubicin followed by one cycle of high-dose cytarabine. In March 2006, the patient relapsed, and he received dose number one of the first cycle of gemtuzumab ozogamicin at a dose of 9 mg/m2 on March 28, 2006. He tolerated the infusion. He had received multiple platelet transfusions during the week before gemtuzumab infusion without reaction but received no transfusions on the same day as the gemtuzumab infusion. On April 4, 2006, the patient received an infusion of gemtuzumab at 11 a.m., and he received 6 units of leukocyte-depleted, irradiated platelets at 6:40 p.m. At 1 a.m. the next morning, the patient developed fever and shortness of breath and went into severe distress. Despite treatment, the patient died shortly after. A patient with AML developed severe respiratory distress and died after receiving gemtuzumab and 6 units of platelets on the same day. The fact that he had previously received gemtuzumab and platelets safely on separate days suggests that the gemtuzumab-platelet combination contributed to a fatal hypersensitivity reaction.