Mylotarg Medication Guide: Infusion Speed, Preprocessing, and Dose Adjustment

Mylotarg is an antibody drug conjugate targeting CD33, used for CD33 positive acute myeloid leukemia. Standardizing infusion speed, pre-treatment, and dose adjustment are key to ensuring safety.

1、 Intravenous infusion speed

1. First infusion

Initial rate: 2mg/m ²/h.

Observation period: Close monitoring of vital signs for the first 30 minutes.

Total duration: ≥ 2 hours, with good tolerance to accelerate every 30 minutes.

2. Subsequent infusion

If there is no serious reaction for the first time, the infusion time can be shortened to ≥ 1 hour.

The maximum speed is not recommended to exceed 4mg/m ²/h.

3. Precautions

It is recommended to use an infusion pump for constant speed administration.

If there is an infusion reaction, it should be immediately paused and evaluated before restarting at a slower rate.

Observe for at least 2 hours after infusion.

2、 Pre treatment before administration

Objective: To minimize the risk of infusion reactions and allergies.

Standard protocol (30-60 minutes before administration):

Antihistamines: Diphenhydramine 25-50mg (intravenous/oral).

Antipyretic and analgesic drugs: Acetaminophen 650-1000mg (oral).

Corticosteroids: methylprednisolone 50-100mg or hydrocortisone 100mg (intravenous).

Antiemetic medication: If necessary, add 5-HT3 receptor antagonists (such as ondansetron).

Special adjustment: For patients with mild infusion reactions in the past, hormone dosage can be increased; People with severe allergies are recommended to take medication under supervision.

3、 Dose adjustment strategy

1. Standard Recommended Dose

Single drug (relapsed/refractory AML): 3mg/m ², administered on days 1, 4, and 7, 28 days per cycle.

Combination therapy: usually 3mg/m ² combined with erythromycin and cytarabine.

2. Adjustment based on liver function

ALT/AST2.5~5 × ULN: Delay until recovery ≤ 2.5 × ULN before continuing.

ALT/AST>5 × ULN: pause, consider reducing to 2mg/m ² or stopping medication after recovery.

Total bilirubin>2 × ULN: pause and evaluate, and reduce as appropriate.

3. Adjustment based on bone marrow suppression

ANC<0.5 × 10 ⁹/L or platelet<25 × 10 ⁹/L (not caused by leukemia): Delayed administration until blood count recovery.

Repeated severe bone marrow suppression: reduce to 2mg/m ² in subsequent cycles.

4. Adjustment based on infusion reactions

Mild to moderate reactions: pause → symptomatic treatment → restart at half speed.

Severe reaction/anaphylactic shock: permanent discontinuation of medication.

5. Special populations

Moderate to severe liver dysfunction: Prohibited or reduced dosage (requires specialist consultation).

Elderly patients (≥ 65 years old): No need for pre dose reduction, but need to strengthen monitoring.