Rapid Infusion Rituximab for Maintenance Therapy: Is It Feasible?

Rituximab is an anti-CD-20 monoclonal antibody used in the management of lymphoproliferative disorders. The use of maintenance rituximab has improved progression free survival and overall survival in follicular lymphomas. Although rapid rituximab infusions have been studied extensively, there is little data on the use of rapid infusions during maintenance therapy for low grade lymphomas. The primary objective of this retrospective analysis was to evaluate the incidence of Grade 3 and 4 toxicities with maintenance rapid infusion rituximab according to the Common Terminology Criteria for Adverse Events version 4 (CTC v. 4). Secondary objectives included evaluating all grade infusion related adverse events and correlation of adverse events with varying schedules of rituximab maintenance therapy. All patients who received rapid infusion rituximab as maintenance therapy for low grade lymphoma between December 2007 and November 2011 were included. Rapid rituximab infusions were administered over 90 minutes. Demographic, laboratory and clinical data were collected. A total of 109 patients received 647 rapid rituximab infusions. Three patients experienced an adverse reaction which resulted in one grade 1 infusion reaction and three grade 3 infusion reactions. No patients required hospitalization. All 3 patients received pharmacological and/or supportive care to relieve symptoms associated with the reaction. 1. Introduction Rituximab (Rituxan) is a chimeric IgG1 monoclonal antibody that targets the CD20 receptor and is used in the management of lymphoproliferative disorders. Rituximab is FDA approved in the treatment of chronic lymphocytic leukemia (CLL), non-Hodgkin’s lymphoma (NHL), and rheumatoid arthritis (RA). Rituximab is generally well tolerated; however, there are risks associated with infusion-related toxicity including hypersensitivity reactions such as fever, urticaria, hypotension, and cardiovascular and respiratory compromise [1]. The mechanism by which rituximab causes an infusion-related reaction is unclear but is thought to be due to the release of inflammatory cytokines [1]. The likelihood of infusion-related reactions is the highest with the first infusion and decreases with subsequent infusions with time to onset ranging from 30 to 120 minutes [2]. Other risk factors for developing an infusion-related reaction include large tumor burden, pulmonary infiltrates, elderly patients, and individuals diagnosed with chronic lymphocytic leukemia or mantle cell lymphoma [1]. Infusion related reactions typically resolve with supportive care and/or a