Gemtuzumab is an antibody drug conjugate targeting CD33, used to treat CD33 positive acute myeloid leukemia. Its therapeutic effect is definite, but side effects also need to be highly valued. This article will provide systematic management recommendations around three core side effects - bleeding, infection, and elevated transaminase levels.

1、 Scientific response to bleeding risk

1.1 Platelet transfusion strategy

Platelet threshold management: When the platelet count is below 10 × 10 ⁹/L or there is active bleeding, active platelet transfusion is required.

Preventive infusion: Before performing invasive procedures, the platelet count should be increased to 40-50 × 10 ⁹/L or above.

Invalid transfusion treatment: If platelet transfusion is ineffective, HLA antibodies should be screened and matching platelet transfusion should be considered.

1.2 Medications and Life Details

Discontinue anticoagulant/antiplatelet drugs: During treatment, aspirin, clopidogrel, warfarin and other drugs should be temporarily suspended (risk assessment by cardiology department is required).

Avoid traumatic operations: Use a soft bristled toothbrush, electric shaver, and avoid blowing your nose forcefully.

Early warning: Patients need to be aware of bleeding signals such as increased skin bruising, gum bleeding, and black stools, and report to medical staff immediately once they appear.

2、 Systematic prevention and control of infection risk

2.1 Infection prevention during granulocyte deficiency

Jitumumab often leads to persistent neutropenia and significantly increases the risk of infection.

Preventive anti infection: It is recommended to use fluoroquinolone drugs (such as levofloxacin) for bacterial prevention; High risk patients can be treated with antifungal prophylaxis (such as posaconazole).

Growth factor support: Granulocyte colony-stimulating factor (G-CSF) can shorten the duration of neutropenia, but it should be noted that it may exacerbate transaminase elevation.

Environment and Hand Hygiene: Strictly implement hand hygiene, patients can live comfortably in single rooms, and visits are reduced.

2.2 Management of febrile neutropenia (FN)

Immediate initiation of empirical antimicrobial therapy: Within 1 hour after the occurrence of FN, blood cultures are collected and broad-spectrum antibiotics (such as cefepime or carbapenems) are administered.

Downgrading strategy: After the pathogen results are clear, targeted selection of sensitive antibiotics is carried out to reduce the occurrence of drug resistance.

Dynamic monitoring: Daily assessment of body temperature, hemodynamics, and signs of infection, and upgrading of anti infection plans if necessary.