Rapid infusion rituximab in combination with corticosteroid-containing chemotherapy or as maintenance therapy is well tolerated and can safely be delivered in the community setting

Sehn, Laurie H.; Donaldson, Jane; Filewich, Allison; Fitzgerald, C. P.; Gill, Karamjit; Runzer, Nancy; Searle, Barb; Souliere, Sheila; Spinelli, John J.; Sutherland, Judy; Connors, Joseph M.

doi:10.1182/blood-2006-11-059469

Cited by 92 publications

(88 citation statements)

References 12 publications

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“…Most IRRs usually develop during the infusion of the first 25-50 mg of rituximab [18] and the initial rate of injection is an important risk factor in the development of IRRs [2]. Previous research on reducing the injection time of rituximab recommended that no more than 20% of the entire injection amount be administered during the first 30 min in order to minimize the occurrence of IRRs [21,22]. In our study, the total injection amount was notably high in the IRR group, and significantly more IRRs occurred when the rate of injection was high during the first 30 min.…”

Section: Discussionmentioning

confidence: 99%

The Incidence and Risk Factors of Infusion-Related Reactions to Rituximab for Treating B Cell Malignancies in a Single Tertiary Hospital

Jung

Kang²,

Lee

et al. 2014

Oncology

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Background: Rituximab is a chimeric anti-CD20 human/mouse monoclonal antibody. As its usage has increased, there have been growing concerns about rituximab-related infusion-related reactions (IRRs). Objective: The aim of this study is to verify the clinical features and risk factors of IRRs by rituximab, and to help establish clinical guidelines for their prevention. Methods: We reviewed electronic medical records of all the adult patients who were prescribed rituximab from January 2005 to July 2010 for B cell malignancy at Seoul National University Hospital. Results: A total of 389 cases of IRRs by rituximab (12.5% of a total of 3,104 infusions) were identified in 281 patients (49.4% of a total of 568 patients). IRRs most frequently occurred during the first infusion (40.5%) and abruptly decreased in subsequent infusions to rates of 3-8% (p < 0.001). The incidence of IRRs in patients premedicated with corticosteroid for their first infusion was significantly lower when compared to patients not pretreated with corticosteroid prior to rituximab infusion (8.3 vs. 41.2%, p = 0.017). Conclusion: Almost half of all patients in the study experienced IRRs at least once during their scheduled rituximab treatment. Premedication with corticosteroid can be recommended in patients with high risk of IRR in the first infusion.

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Section: Discussionmentioning

confidence: 99%

The Incidence and Risk Factors of Infusion-Related Reactions to Rituximab for Treating B Cell Malignancies in a Single Tertiary Hospital

Jung

Kang²,

Lee

et al. 2014

Oncology

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“…The safety and feasibility of this schedule was confirmed by a retrospective analysis of a further 1,200 patients treated in British Columbia (12). In this study, part of the rituximab administrations was given as maintenance; in 52 of these cases, treatment was given without steroid premedication without any grade 3-4 toxicities being observed.…”

Section: Discussionmentioning

confidence: 87%

A Phase I-II Study to Determine the Maximum Tolerated Infusion Rate of Rituximab with Special Emphasis on Monitoring the Effect of Rituximab on Cardiac Function

Siano

Lerch

Negretti

et al. 2008

Clinical Cancer Research

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Purpose: This phase I infusion rate escalation trial was undertaken to evaluate the maximum applicable infusion rate for rituximab without steroid premedication in patients having received one previous rituximab infusion. Experimental Design: Cohorts of at least three patients were assigned to rituximab with or without concomitant chemotherapy. The initial infusion rate was 200 mg/h in the first cohort, and was increased by 100 mg/h in each subsequent cohort to a maximum of 700 mg/h. In each patient the infusion rate was increased by 100 mg/h every 30 minutes to the total dose (375 mg/m 2 ). In the first six cohorts (21 patients), two well-tolerated rituximab administrations were required; in the 7th cohort (11 patients) one previously well-tolerated rituximab infusion was required. Patients did not receive steroid premedication and were monitored with electrocardiograms (ECG), echocardiograms, Holter ECGs, troponin, and brain natriuretic peptide (BNP). Results: Thirty-two patients were included and 128 cycles were done, 85 at a rate of 700 mg/h. Patients tolerated infusion rates without major side effects. There were no new clinically relevant ECG alterations. Troponin (< 0.1ng/L) and mean cardiac ejection fraction (65%) remained in the reference range; BNP baseline level increased significantly 24 hours after rituximab administration (from 30.4 to 64.1ng/L; P < 0.0001).Conclusions: Rituximab can be administered safely at 700 mg/h without steroid premedication in patients having received at least one rituximab dose in the previous 3 months.Rituximab is a monoclonal antibody against the lymphocyte surface antigen CD20. First introduced in 1995 for the treatment of non -Hodgkin's B-lymphoma, rituximab has today a broad spectrum of indications, including treatment of rheumatoid arthritis, thrombotic thrombocytopenic purpura, and systemic lupus erythematosis, among many others (1 -6). Treatment with rituximab is generally well tolerated and can be combined with chemotherapy, improving response rate, response duration, and in some cases overall survival of patients with B-cell lymphomas (1). Infusion-related reactions can occur in approximately one fourth of patients during the first administration, probably due to a release of cytokines into the blood as a consequence of the rapid destruction of circulating B cells (7). This is why it is recommended to choose a low initial infusion rate. The incidence and the severity of infusion-related side effects consistently decrease in the successive administrations; indeed after the second rituximab infusion almost no B cells are left in the blood for at least 2 to 3 months. The reconstitution begins usually after 6 months and is completed after a median of 12 months (8, 9). We hypothesized that no infusion-related reaction should occur from the second infusion, and that a faster application of rituximab could be considered safe. Although the duration of the infusion is usually 4 to 5 hours for the first administration, the present study was undertaken to evaluate i...

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“…In contrast, humanized anti-CD20 MAbs will find a place in the therapeutic armamentarium of B-cell malignancies only if ongoing clinical trials demonstrate that they are far better than rituximab, if they are active against Bcell lymphomas in which rituximab has minimal activity (i.e., CLL, MCL), or if they are shown to have clinical activity in rituximab-refractory patients. The recent demonstration that rituximab infusion can be safely administered over 90 minutes in patients with B-cell NHL 40 has raised the bar further for humanized anti-CD20 MAb since one of the potential advantages of these novel antibodies was precisely to allow shorter infusion time relative to the slow and gradually increasing speed used in rituximab treatment.…”

Section: Novel Anti-cd20 Monoclonal Antibodiesmentioning

confidence: 99%

Monoclonal Antibodies for B-Cell Lymphomas: Rituximab and Beyond

Bello¹,

Sotomayor²

2007

Hematology

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Rapid infusion rituximab in combination with corticosteroid-containing chemotherapy or as maintenance therapy is well tolerated and can safely be delivered in the community setting

Cited by 92 publications

References 12 publications

The Incidence and Risk Factors of Infusion-Related Reactions to Rituximab for Treating B Cell Malignancies in a Single Tertiary Hospital

The Incidence and Risk Factors of Infusion-Related Reactions to Rituximab for Treating B Cell Malignancies in a Single Tertiary Hospital

A Phase I-II Study to Determine the Maximum Tolerated Infusion Rate of Rituximab with Special Emphasis on Monitoring the Effect of Rituximab on Cardiac Function

Monoclonal Antibodies for B-Cell Lymphomas: Rituximab and Beyond

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