Manipulation of monoclonal antibodies: what impact on the health of manipulators and what organization to adopt?

Context

The use of monoclonal antibodies (MAbs) is in full swing, but the health consequences of regular manipulators, especially nurses, are not well known. On returning from the congress, our medical doctor approached the pharmacy to ask if the use of spikes for the reconstitution of the mAbs was a means of protection. In front of this question, and the increase mAb prescriptions, it was decided to make a point about their toxicities.

Materials and methods

Review of the bibliography concerning the toxicity of monoclonal antibodies on manipulators.
Results compiled in a table. The antibodies were grouped into 4 classes, according to their level of toxicity (class 1 being the most dangerous).

Results

In our establishment, 23 antibodies are used regularly. Among these 23 mAbs, 9 are prepared in the Central Anticancer Preparation Unit (UPCA), in a specific isolator in vacuum. The other 14 are directly prepared in the services.
8 mAbs belong to class 1 and 2, 8 in class 3 and 7 in class 4 (no toxicity).
8 Acm font partie de la classe 1 et 2, 8 dans la classe 3 et 7 dans la classe 4 (aucune toxicité).

A very few studies about their toxicities for manipulators, was found on the litterature:

• 16 mAbs (70%) have data on their reprotoxicity,
• 2 mAbs (9%) on carcinogenicity,
• 6 mAbs (26%) on their genotoxicities.
• 8 mAbs (35%) have no data on their potential toxicities.
  They have in common a sensitization of the regular manipulator which will deprive him of a use of this therapeutics.

Discussion and conclusion

The use of spikes is not a solution, which is why a reflection has been initiated on:

• the training of nurses in the services,
• the use of closed systems,
• the preparation of all mAbs in UPCA.

This reflection is also focused on the 3rd class mAbs, which is a boundary class. Their toxicity is considered unimportant, but precautionary measures for prevention seems indispensable.