Multimodal Analgesic Plan for Children Undergoing Chimeric 14.18 Immunotherapy

Area of Science:

• Pediatric Oncology
• Pain Management
• Immunotherapy

Background:

• Chimeric 14.18 anti-GD2 antibody (ch14.18) immunotherapy is crucial for treating neuroblastoma.
• Severe neuropathic pain and adverse events like desaturation, bradycardia, and hypotension are common challenges during ch14.18 therapy.
• Current analgesic strategies for ch14.18-induced pain have limitations.

Purpose of the Study:

• To assess the efficacy of a multimodal analgesic regimen.
• To evaluate pain control and side effects during ch14.18 infusion.
• To determine if gabapentin, ketamine, and morphine can improve pain management in this context.

Main Methods:

• Retrospective analysis of patient data.
• Evaluation of a multimodal regimen including gabapentin, ketamine, and morphine.
• Assessment of pain levels, morphine consumption, and adverse events (desaturation, bradycardia, hypotension).

Main Results:

• The multimodal regimen resulted in low reported pain levels.
• Desaturation and hypotension were infrequent.
• No episodes of bradycardia were observed during the regimen's use.
• Morphine consumption was comparable to other studies.

Conclusions:

• The multimodal regimen of gabapentin, ketamine, and morphine appears effective for managing pain during ch14.18 immunotherapy.
• This approach may reduce the incidence of severe side effects associated with ch14.18.
• The findings suggest this regimen as a potentially valuable analgesic option for pediatric patients receiving ch14.18.