Interstitial Pneumonitis Related to Rituximab Therapy

Burton, Catherine; Kaczmarski, Richard; Jan-Mohamed, Riaz

doi:10.1056/nejm200306263482619

Cited by 140 publications

(26 citation statements)

References 6 publications

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“…Based on a Medline search and review of all references in cited papers, table 1 summarizes the available experience of rituximab-induced pulmonary toxicity [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16], which includes 14 patients with interstitial pneumonitis [3,5,6,7,9,10,11,12,13,14,15], 3 patients with bronchiolitis obliterans with organizing pneumonia [4, 6, 16] and, including the patient presented here, 2 patients with an interstitial process characterized by loosely formed granulomata and diffuse alveolar hemorrhage [2]. In contrast to the previously reported individual with diffuse alveolar hemorrhage, whose respiratory status worsened to require intubation and mechanical ventilation, our patient demonstrated a rapid and impressive improvement, temporally associated with his receipt of systemic corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

Interstitial Pneumonitis and Alveolar Hemorrhage Complicating Use of Rituximab

2007

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Section: Discussionmentioning

confidence: 99%

Interstitial Pneumonitis and Alveolar Hemorrhage Complicating Use of Rituximab

2007

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“…Regarding acute drug-induced iatrogenic respiratory toxicity there exist several excellent reviews, statements, and book chapters, including an Internet address (www.pneumotox.com), where the reader is directed to seek advice [210,211]. Drugs commonly used in CTDs and the most common acute adverse events are reported in table 2 [22,45,212,213,214,215,216,217,218,219,220,221,222,223,224,225,226]. …”

Section: Acute Antirheumatic Drug-related Respiratory Toxicitymentioning

confidence: 99%

Acute Respiratory Events in Connective Tissue Disorders

Papiris¹,

Manali²,

Kolilekas³

et al. 2016

Respiration

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Subacute-acute, hyperacute, or even catastrophic and fulminant respiratory events occur in almost all classic connective tissue disorders (CTDs); they may share systemic life-threatening manifestations, may precipitously lead to respiratory failure requiring ventilatory support as well as a combination of specific therapeutic measures, and in most affected patients constitute the devastating end-of-life event. In CTDs, acute respiratory events may be related to any respiratory compartment including the airways, lung parenchyma, alveolar capillaries, lung vessels, pleura, and ventilatory muscles. Acute respiratory events may also precipitate disease-specific extrapulmonary organ involvement such as aspiration pneumonia and lead to digestive tract involvement and heart-related respiratory events. Finally, antirheumatic drug-related acute respiratory toxicity as well as lung infections related to the rheumatic disease and/or to immunosuppression complete the spectrum of acute respiratory events. Overall, in CTDs the lungs significantly contribute to morbidity and mortality, since they constitute a common site of disease involvement; a major site of infections related to the ‘mater' disease; a major site of drug-related toxicity, and a common site of treatment-related infectious complications. The extreme spectrum of the abovementioned events, as well as the ‘vicious' coexistence of most of the aforementioned manifestations, requires skills, specific diagnostic and therapeutic means, and most of all a multidisciplinary approach of adequately prepared and expert scientists. Avoiding lung disease might represent a major concern for future advancements in the treatment of autoimmune disorders.

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“…The first case of mAB-induced lung disease (mAB-ILD) was reported in 2003 with rituximab [3]. Since then, over 150 cases have been reported in the literature.…”

Section: Introductionmentioning

confidence: 99%

Bronchoalveolar Lavage Cellular Patterns in Monoclonal Antibody-Induced Lung Disease

et al. 2014

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Background: The increase in the use of monoclonal antibodies (mAB) as a targeted therapy for a variety of diseases has been accompanied by an increase in reports of interstitial lung abnormalities in treated patients. Objective: Bronchoalveolar lavage (BAL) is routinely performed in these patients to rule out infection, so we sought to determine the BAL cellular pattern in individuals with mAB-induced lung disease (mAB-ILD). Methods: We utilized a case-control study design. Among patients treated with mAB, cases were defined as those with otherwise-unexplained interstitial lung abnormalities, which resolved after cessation of treatment, while controls were defined as those with interstitial abnormalities clearly explained by other etiologies. Results: From 2000 to 2012, we identified 9 cases and 7 controls. The mean age of the cases was 62.6 ± 26 years and 6 were female. The most common radiographic finding was diffuse ground-glass opacities. The most common BAL cellular pattern was mixed inflammation with moderate lymphocytic and mild neutrophilic alveolitis. The cases had a higher mean lymphocyte count than the controls (40.1 ± 32.6 vs. 13.1 ± 25.5, p = 0.008). The rest of the BAL cellular analyses were similar between the 2 groups. The median CD4:CD8 ratio in 7 patients with >15% lymphocytes was 0.9 (0.6-3). There was no significant difference in the CD4:CD8 ratio between the 2 groups. Conclusions: Mixed inflammation with moderate lymphocytic and mild neutrophilic alveolitis is the most common BAL cellular pattern in patients with mAB-ILD. Such findings may be useful for the early identification of mAB-ILD.

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Interstitial Pneumonitis Related to Rituximab Therapy

Cited by 140 publications

References 6 publications

Interstitial Pneumonitis and Alveolar Hemorrhage Complicating Use of Rituximab

Interstitial Pneumonitis and Alveolar Hemorrhage Complicating Use of Rituximab

Acute Respiratory Events in Connective Tissue Disorders

Bronchoalveolar Lavage Cellular Patterns in Monoclonal Antibody-Induced Lung Disease

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