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Immune-related Adverse Events from Immune Checkpoint Inhibitor Therapy

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13 Contraindications and Cautions IVIG is contraindicated in those with a history of anaphylactic or severe systemic reaction to human immune globulin, hyperprolinemia or IgA-deficient patients with antibodies to IgA and a history of hypersensitivity. Warning for IVIG use that thrombosis and renal dysfunction in predisposed patients can occur. For patients at risk of thrombosis, renal dysfunction, or failure, administer IVIG at the minimum dose and infusion rate practicable. Ensure adequate hydration in patients before administration. Monitor for signs and symptoms of thrombosis and assess blood viscosity in patients at risk for hyperviscosity. Contraindicated in pregnant women, or women of childbearing potential who are not using reliable contraception, patients with pre-existing acute or chronic liver disease, or those with serum ALT >2× ULN before initiating treatment, patients with known hypersensitivity to leflunomide or any of the other components of leflunomide and patients being treated with teriflunomide. Severe liver injury, including fatal liver failure, has been reported in some patients treated with leflunomide. Leflunomide is not recommended for patients with severe immunodeficiency, bone marrow dysplasia, or severe, uncontrolled infections. Contraindicated in pregnancy, alcoholism or liver disease, immunodeficiency syndromes, preexisting blood dyscrasias, hypersensitivity to methotrexate. Warnings for methotrexate include potential for organ system toxicity, may cause impairment of fertility, oligospermia and menstrual dysfunction, elimination is reduced in patients with impaired renal function, ascites, or pleural effusions, may cause dizziness and fatigue, may impair ability to drive or operate machinery MMF is contraindicated in patients with hypersensitivity to mycophenolate mofetil, MPA acid, or any component of the drug product and in patients allergic to Polysorbate 80. Warning that use during pregnancy is associated with increased risks of first trimester pregnancy loss and congenital malformations. Females of reproductive potential must be counseled regarding pregnancy prevention and planning. ere is an increased risk of the development of lymphoma and other malignancies, particularly of the skin. ere is also an increased susceptibility to infections, including opportunistic infections and severe infections with fatal outcomes. Contraindications include hemodynamic instability or septicemia, known allerg y to fresh frozen plasma or replacement colloid/albumin, known allerg y to heparin. Warning that complications may occur, including hypocalcemia or hypomagnesemia, hypothermia, transfusion reactions, fluid and electrolyte imbalance, bleeding diatheses, hypotension, flushing, and GI symptoms like nausea and vomiting.

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