Pain mitigation and management strategies for anti-GD2 infusions: An expert consensus

Karsten Nysom, Andrea Gomez Morad, Margarida Simão Rafael, Judith Zier, Araz Marachelian, Tanya Watt, Daniel A. Morgenstern

Research output: Contribution to journalArticlepeer-review


Monoclonal antibodies (mAbs) targeting disialoganglioside 2 (GD2) are an important treatment advance for high-risk neuroblastoma, including in patients with refractory or relapsed disease. Dinutuximab and dinutuximab beta are administered for ≥8 hours (and up to 10 days for dinutuximab beta), whereas naxitamab is administered over 0.5 to 2 hours as tolerated. As acute pain is a class effect of anti-GD2 mAbs, effective pain management is crucial to successful treatment. Here, we provide an overview of current pain-management strategies for anti-GD2 mAb infusions, with a focus on strategies suitable for naxitamab infusions, which cause a more rapid onset of often severe pain. We discuss opioid analgesics, ketamine, gabapentin, and other similar agents and nonpharmacologic approaches. Potential future pain-management options are also discussed, in addition to the use of sedatives to reduce the anxiety that may be associated with infusion-related pain. In this expert consensus paper, specific guidance for pain management during naxitamab infusions is provided, as these infusions are administered over 0.5 to 2 hours and may not need overnight hospitalization based on the physician's assessment, and require rapid-onset analgesia options suitable for potential outpatient administration.

Original languageEnglish (US)
JournalPediatric Blood and Cancer
StateAccepted/In press - 2023


  • Antibodies
  • drug therapy
  • humanized
  • immunotherapy
  • monoclonal
  • neuroblastoma
  • pain

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology


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