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Lidocaine for dinutuximab associated pain? A multicenter retrospective observational cohort study
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  • Julianna Featherly,
  • Sarabeth Wojnowicz,
  • Kelly Steidl,
  • Jeni Burgess
Julianna Featherly
Upstate University Hospital
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Sarabeth Wojnowicz
Upstate University Hospital
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Kelly Steidl
Upstate University Hospital
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Jeni Burgess
Upstate University Hospital
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Abstract

Dinutuximab, an immune-mediated therapy used in the treatment of high-risk neuroblastoma targets the protein disialoganglioside (GD2) present on neuroblastoma cells, neurons, and peripheral nerve fibers. Off target effects could lead to severe nerve pain. Pain regimens including continuous infusion opioids are required during the first treatment course. Our institution utilizes a combination of intravenous (IV) lidocaine infusions and morphine for the treatment of dinutuximab-associated neuropathic pain. The primary outcome of this study was to compare morphine equivalents for cycle one of dinutuximab at an institution that uses IV lidocaine (primary) versus those that do not (comparison). Secondary outcomes included both dinutuximab infusion time and safety of IV lidocaine. A retrospective, multi-centered, electronic chart review was performed at three tertiary academic medical centers. Patients between 0-18 years of age during their first course of dinutuximab were included to evaluate the primary outcome of adjuvant morphine equivalents needed. Total morphine equivalents at the primary institution were 1.87 mg/kg vs 1.79 mg/kg at the comparison institutions (p=0.413). Dinutuximab infusion time was significantly lower at the primary institution: 610.5 minutes vs 676.23 minutes (p=0.046). Only one patient at the primary institution experienced nausea, vomiting and paresthesias. This study did not find a statistically significant difference in morphine equivalents between patients who received IV lidocaine and those who did not. However, we did find that use of IV lidocaine resulted in a statistically significant lower dinutuximab infusion time and that it is a safe adjuvant medication in the treatment of dinutuximab-associated neuropathic pain.

Peer review status:IN REVISION

01 Jul 2021Submitted to Pediatric Blood & Cancer
01 Jul 2021Assigned to Editor
01 Jul 2021Submission Checks Completed
06 Jul 2021Reviewer(s) Assigned
19 Jul 2021Review(s) Completed, Editorial Evaluation Pending
03 Aug 2021Editorial Decision: Revise Major