Rituximab and Cytokine Release Syndrome

Kulkarni, Hrishikesh S.; Kasi, Pashtoon Murtaza

doi:10.1159/000337577

Cited by 43 publications

(35 citation statements)

References 12 publications

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“…The proposed mechanism is the reduction of viral load via destruction of the reservoir of EBV-infected cells. Unfortunately, RTX therapy has been shown to induce CRS, probably caused by the rapid destruction of tumor cells and consequent changes of serum cytokine levels [98]. It seems that CRS is a side effect of RTX therapy considering that it occurs mainly in patients with a very high tumor burden.…”

Section: B Cell Inhibitorsmentioning

confidence: 99%

Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and Autoimmunity

Picchianti-Diamanti

Rosado

Pioli

et al. 2020

IJMS

103

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On 7 January 2020, researchers isolated and sequenced in China from patients with severe pneumonitis a novel coronavirus, then called SARS-CoV-2, which rapidly spread worldwide, becoming a global health emergency. Typical manifestations consist of flu-like symptoms such as fever, cough, fatigue, and dyspnea. However, in about 20% of patients, the infection progresses to severe interstitial pneumonia and can induce an uncontrolled host-immune response, leading to a life-threatening condition called cytokine release syndrome (CRS). CRS represents an emergency scenario of a frequent challenge, which is the complex and interwoven link between infections and autoimmunity. Indeed, treatment of CRS involves the use of both antivirals to control the underlying infection and immunosuppressive agents to dampen the aberrant pro-inflammatory response of the host. Several trials, evaluating the safety and effectiveness of immunosuppressants commonly used in rheumatic diseases, are ongoing in patients with COVID-19 and CRS, some of which are achieving promising results. However, such a use should follow a multidisciplinary approach, be accompanied by close monitoring, be tailored to patient's clinical and serological features, and be initiated at the right time to reach the best results. Autoimmune patients receiving immunosuppressants could be prone to SARS-CoV-2 infections; however, suspension of the ongoing therapy is contraindicated to avoid disease flares and a consequent increase in the infection risk.

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Section: B Cell Inhibitorsmentioning

confidence: 99%

Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and Autoimmunity

Picchianti-Diamanti

Rosado

Pioli

et al. 2020

IJMS

103

View full text Add to dashboard Cite

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“…Rituximab in combination with other chemotherapeutic agents may be used in transplant ICUs, depending on disease severity. However, treatment-associated mortality occurs in up to 11% of patients with PTLD [21,22]. …”

Section: Introductionmentioning

confidence: 99%

Clinical review: Serious adverse events associated with the use of rituximab - a critical care perspective

et al. 2012

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The advent of biologic agents has provided a more specific and targeted approach to the treatment of various hematological malignancies and other autoimmune disorders. Such biologic agents have been relatively well tolerated with fewer adverse events reported as compared with many other chemotherapeutic agents. Rituximab is a monoclonal antibody to the B-cell marker CD20 and is a common biologic agent widely used for the treatment of B-cell lymphoma, lymphoproliferative disorders, and inflammatory conditions that are refractory to conventional treatment, including rheumatoid arthritis and some vasculitides. However, through randomized controlled trials and post-marketing surveillance, an increasing number of serious adverse events are being associated with the use of rituximab, often leading to or complicating an intensive care unit admission. The purpose of this review is to focus on the severe complications that are associated with the use of rituximab and that require critical care. Management and prevention strategies for the most common complications along with some examples of its uses within the critical care setting are also discussed.

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“…They theorized that an imbalance between B‐cell and T‐cell populations in the CNS might have triggered a predominantly cell‐mediated immune attack against unidentified nervous system antigens. Rituximab administration rarely causes serious adverse events; however, it may lead to complement activation, cell lysis and subsequent massive release of cytokines, culminating in cytokine release syndrome and systemic inflammatory response syndrome . This could, in part, explain the early development of PRES after rituximab in some patients.…”

Section: Discussionmentioning

confidence: 99%