Safety of fractionated dose of rituximab in renal failure patients receiving hemodialysis

Ostronoff, Fabiana; Ostronoff, M; Florêncio, Rodrigo; Matias, Carla; Maior, Ana Patricia Souto; Domingues, Mariana; Calixto, Robson Diego; Sucupira, Alexandre; Matias, Katherine Aquino; Tagliari, C.

doi:10.1080/10428190500398849

Cited by 4 publications

(6 citation statements)

References 6 publications

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“…Pharmacokinetic studies on rituximab in patients with end-stage renal disease demonstrated that this agent is not eliminated by dialysis [11]. Similarly, the use of vincristine is safe in severe renal failure (<30 ml/min), with no need for dose adjustment [8].…”

Section: Discussionmentioning

confidence: 99%

Treatment of a Frail Older Patient with Diffuse Large B-Cell Lymphoma on Maintenance Dialysis: Attenuated Immunochemotherapy and Adapted Care Plan

Pontes¹,

Todaro

Karnakis

et al. 2013

Case Rep Oncol

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Purpose of the Study: Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoid malignancy worldwide. Its incidence increases with age and about 40% of cases occur in patients over 70 years. Herein, we describe a case of a frail elderly patient with renal insufficiency and DLBCL treated with R-mini-CHOP. Case Report: A 77-year-old man on maintenance hemodialysis started experiencing persistent fatigue. He was diagnosed with a large mass on the left lobe of the lung. Biopsy demonstrated a DLBCL, CD20 positive. The patient was assigned clinical stage IIBX, with a high age-adjusted international prognosis index. A proper geriatric assessment revealed a frail patient. Thus, an adapted chemotherapy regimen was proposed which consisted of R-mini-CHOP every 21 days, with a reduction of 10% in the doses of doxorubicin and cyclophosphamide. During the treatment, the patient went through regular dialysis sessions, 3 times per week, with an extra session performed 12 h after each chemotherapy administration. The patient experienced no adverse events or grade 3/4 toxicities. After 6 cycles of R-mini-CHOP, the patient achieved unconfirmed complete remission, and consolidation radiotherapy was performed. At the last follow-up, he was still in unconfirmed complete remission, with a progression-free survival of 11.3 months. Conclusions: R-mini-CHOP represented a reasonable treatment option for this patient with renal failure. The oncogeriatric approach led to a successful management of this frail patient, highlighting that an adapted plan of care is a key issue to improve the outcomes of elderly cancer patients.

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Section: Discussionmentioning

confidence: 99%

Treatment of a Frail Older Patient with Diffuse Large B-Cell Lymphoma on Maintenance Dialysis: Attenuated Immunochemotherapy and Adapted Care Plan

Pontes¹,

Todaro

Karnakis

et al. 2013

Case Rep Oncol

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“…The commonest etiology of acquired FVIII: C inhibitor in nonhemophilia patients is idiopathic. [6][7][8] The fact that rituximab is a 145 kDa molecule, suggests that no dose adjustment is needed in patients on HD. Systemic lupus erythematosus contributes to about 6.2% 2-4 of such cases.…”

Section: Discussionmentioning

confidence: 99%

“…The experience on this issue is limited. [6][7][8] The fact that rituximab is a 145 kDa molecule, suggests that no dose adjustment is needed in patients on HD. Because, angio-edema has been reported during infusion of rituximab, we recommend that the dose be given on non-HD days due to a theoretical risk of higher incidence in some patients who may have reaction to certain dialyzers.…”

Section: Discussionmentioning

confidence: 99%

Acquired factor VIII inhibitor in a nonhemophilia patient on hemodialysis: challenges in management

Phadke

Gupta

Botdorf

et al. 2010

Hemodialysis International

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It is well known that the uremic milieu predisposes patients to an increased risk of bleeding. We report a case of a patient on hemodialysis who developed recurrent unexplained bleeding episodes. His renal failure was secondary to systemic lupus erythematosus. Further investigations revealed that his bleeding was secondary to the development of acquired inhibitors to factor VIII: C following a flare up of his systemic lupus erythematosus. Management issues related to recurrent bleeding in this situation are discussed and reviewed.

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“…This agent does not require dose modification in the renal setting; however, it could be responsible for acute and often severe fluid retention (ATRA syndrome), thus requiring careful management and accurate water balance monitoring [78,79]. The novel proteasome inhibitor bortezomib [80], which is used in the management of MM and in selected cases of others HM, and the monoclonal antibody rituximab [81,82], which represents an essential agent for the treatment of most lymphoproliferative disorders, have been safely administered at full doses to patients with RI and to those on HD. Of note, sustained therapeutic serum levels of rituximab comparable with patients with normal renal function were achieved after the infusion of this agent after HD, and no rituximab clearance into the dialysate was found.…”

Section: Reviewmentioning

confidence: 99%

“…Full dose [81,82] Expert Review of Anticancer Therapy Downloaded from informahealthcare.com by University of Cincinnati on 12/08/14…”

Section: Acute Leukemiasmentioning

confidence: 99%

Management of hematological malignancies in patients affected by renal failure

Niscola

Vischini

Tendas

et al. 2011

Expert Review of Anticancer Therapy

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The management of hematological malignancies (HM) in renally impaired patients may be a difficult task. Indeed, the kidney represents a major elimination pathway for many chemotherapeutic agents and their metabolites, whose serum levels are not usually measured in daily clinical practice. In addition, many antineoplastic drugs have a narrow therapeutic index for which they require dose adjustment when administered to patients with renal failure. Only limited data regarding the use of chemotherapy in patients with renal impairment and in those on dialysis are available. Indeed, renal patients with HM are often excluded from most clinical trials. Thus far, in order to provide recommendations, we have reviewed the pertinent literature, gathering information from published guidelines regarding chemotherapy in patients with kidney dysfunction and from articles describing the use of individual agents in renal patients with HM.

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Safety of fractionated dose of rituximab in renal failure patients receiving hemodialysis

Cited by 4 publications

References 6 publications

Treatment of a Frail Older Patient with Diffuse Large B-Cell Lymphoma on Maintenance Dialysis: Attenuated Immunochemotherapy and Adapted Care Plan

Treatment of a Frail Older Patient with Diffuse Large B-Cell Lymphoma on Maintenance Dialysis: Attenuated Immunochemotherapy and Adapted Care Plan

Acquired factor VIII inhibitor in a nonhemophilia patient on hemodialysis: challenges in management

Management of hematological malignancies in patients affected by renal failure

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