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Pérez‐Persona E, Cuevas Palomares L, Unamunzaga Cilaurren A, Gutiérrez López de Ocáriz X, Buendía Ureña B, Vega González de Viñaspre A, Benito Ibarrondo B, Molinillo Fernández MC, Cordero Osúa A, Benítez Delgado B, García Albás JJ, Andrés Moralejo MÁ, Guinea de Castro JM. Ultrafast 30-min infusion of a rituximab biosimilar (Truxima). EJHAEM 2023; 4:1196-1199. [PMID: 38024594 PMCID: PMC10660389 DOI: 10.1002/jha2.812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023]
Abstract
In this clinical trial, we demonstrate that ultrarapid fast infusion of rituximab (Truxima) in 30 min with oral premedication is feasible and secure for patients, and reduce the day-care hospital stays.
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Affiliation(s)
| | - Laida Cuevas Palomares
- Bioaraba (Onco‐Haematology Group)Vitoria‐GasteizSpain
- Osakidetza (OSI Araba)Hospital Universitario de Álava (Department of Haematology)Vitoria‐GasteizSpain
| | | | | | | | | | | | | | - Ana Cordero Osúa
- Osakidetza (OSI Araba)Hospital Universitario de Álava (Day‐care Unit)Vitoria‐GasteizSpain
| | | | - Juan José García Albás
- Osakidetza (OSI Araba)Hospital Universitario de Álava (Department of Pharmacy)Vitoria‐GasteizSpain
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Hanna KS, Segal EM, Barlow A, Barlow B. Clinical strategies for optimizing infusion center care through a pandemic. J Oncol Pharm Pract 2020; 27:165-179. [PMID: 32972300 DOI: 10.1177/1078155220960211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The national pandemic resulting from the novel coronavirus, COVID-19, has made the delivery of care for patients with cancer a challenge. There are competing risks of mortality from cancer versus serious complications and higher risk of death from COVID-19 in immunocompromised hosts. Furthermore, compounding these concerns is the inadequate supply of personal protective equipment, decreased hospital capacity, and paucity of effective treatments or vaccines to date for COVID-19. Guidance measures and recommendations have been published by national organizations aiming to facilitate the delivery of care in a safe and effective manner, many of which, are permanently adoptable interventions. Given the critical importance to continue chemotherapy, there remains additional interventions to further enhance patient safety while conserving healthcare resources such as adjustments in medication administration, reduction in laboratory or drug monitoring, and home delivery of specialty infusions. In this manuscript, we outline how to implement these actionable interventions of chemotherapy and supportive care delivery to further enhance the current precautionary measures while maintaining safe and effective patient care. Coupled with current published standards, these strategies can help alleviate the numerous challenges associated with this pandemic.
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Affiliation(s)
- Kirollos S Hanna
- Mayo Clinic College of Medicine, Rochester, USA
- M Health Fairview, Maple Grove, USA
| | - Eve M Segal
- Seattle Cancer Care Alliance, University of Washington Medical Center, Seattle, USA
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Gaffney KJ, Dahl EM, Stanton MP, Starek E, Zembillas AS. Rapid-Infusion Rituximab in a Pediatric Population. J Pediatr Pharmacol Ther 2020; 25:215-219. [DOI: 10.5863/1551-6776-25.3.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The use of rapid rituximab infusion in certain pediatric populations has generally been regarded as safe. The safety of our institution's rapid rituximab protocol was evaluated.
METHODS The primary end point was the number of and severity of adverse drug reactions. Secondary end points included a description of the patient population defined by the indication, dose, and number of rituximab infusions administered. Additionally, the difference in infusion times in hours of those receiving rapid rituximab infusions versus the theoretical infusion time of subsequent administration rate schedules was defined.
RESULTS A total of 88 infusions for 22 patients were reviewed. No dose-limiting adverse reactions were observed. Three patients experienced grade 1 isolated infusion-related adverse events during a single infusion encounter. Two of the three patients received additional doses of rapid rituximab infusions without incident, whereas the other patient no longer required rituximab therapy.
CONCLUSIONS The use of a 90-minute rituximab infusion protocol in pediatric patients with non-rheumatic diseases was well tolerated.
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4
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Secondary prophylaxis of an acute coronary syndrome during rituximab infusion. Med Clin (Barc) 2020; 154:69-70. [PMID: 31178296 DOI: 10.1016/j.medcli.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/04/2019] [Indexed: 11/21/2022]
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Bernhardt MB, De Guzman MM, Grimes A, Kirk S, Nelson S, Bergsbaken J, Minard CG, Despotovic JM. Rapid infusion of rituximab is well tolerated in children with hematologic, oncologic, and rheumatologic disorders. Pediatr Blood Cancer 2018; 65. [PMID: 28792663 DOI: 10.1002/pbc.26759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 01/19/2023]
Abstract
Traditional administration of rituximab requires careful titration and may involve many hours to minimize the risk of reactions. The objective of this study was to evaluate the safety of rapid infusions of rituximab in a pilot group of children with hematologic, oncologic, and rheumatologic disorders, and to determine the incidence of rate-related infusion reactions. Twenty patients enrolled in the study. All patients tolerated the rapid infusion of rituximab and no patient had an infusion-related reaction. We conclude that rapid infusions of rituximab are well tolerated and safe in our pilot group of patients.
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Affiliation(s)
| | - Marietta M De Guzman
- Section of Immunology, Allergy, Rheumatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Amanda Grimes
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Texas Children's Cancer and Hematology Center, Houston, Texas
| | - Susan Kirk
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Texas Children's Cancer and Hematology Center, Houston, Texas
| | - Sheryl Nelson
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Charles G Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Jenny McDade Despotovic
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Texas Children's Cancer and Hematology Center, Houston, Texas
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6
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Pavanello F, Zucca E, Ghielmini M. Rituximab: 13 open questions after 20years of clinical use. Cancer Treat Rev 2017; 53:38-46. [DOI: 10.1016/j.ctrv.2016.11.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/20/2016] [Accepted: 11/29/2016] [Indexed: 12/26/2022]
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7
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Gui L, Han X, He X, Song Y, Yao J, Yang J, Liu P, Qin Y, Zhang S, Zhang W, Gai W, Xie L, Shi Y. Phase I study of chimeric anti-CD20 monoclonal antibody in Chinese patients with CD20-positive non-Hodgkin's lymphoma. Chin J Cancer Res 2016; 28:197-208. [PMID: 27199517 PMCID: PMC4865612 DOI: 10.21147/j.issn.1000-9604.2016.02.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE This study was designed to determine the safety, pharmacokinetics and biologic effects of a human-mouse chimeric anti-CD20 monoclonal antibody (SCT400) in Chinese patients with CD20-positive B-cell non-Hodgkin's lymphoma (CD20(+) B-cell NHL). SCT400 has an identical amino acid sequence as rituximab, with the exception of one amino acid in the CH1 domain of the heavy chain, which is common in Asians. METHODS Fifteen patients with CD20(+) B-cell NHL received dose-escalating SCT400 infusions (250 mg/m(2): n=3; 375 mg/m(2): n=9; 500 mg/m(2): n=3) once weekly for 4 consecutive weeks with a 24-week follow-up period. The data of all patients were collected for pharmacokinetics and pharmacodynamics analyses. RESULTS No dose-limiting toxicities were observed. Most drug-related adverse events were grade 1 or 2. Two patients had grade 3 or 4 neutropenia. Under premedication, the drug-related infusion reaction was mild. A rapid, profound and durable depletion of circulating B cells was observed in all dose groups without significant effects on T cell count, natural killer (NK) cell count or immunoglobulin levels. No patient developed anti-SCT400 antibodies during the course of the study. SCT400 serum half-life (T1/2), maximum concentration (Cmax) and area under the curve (AUC) generally increased between the first and fourth infusions (P<0.05). At the 375 mg/m(2) dose, the T1/2 was 122.5±46.7 h vs. 197.0±75.0 h, respectively, and the Cmax was 200.6±20.2 g/mL vs. 339.1±71.0 g/mL, respectively. From 250 mg/m(2) to 500 mg/m(2), the Cmax and AUC increased significantly in a dose-dependent manner (P<0.05). Patients with a high tumor burden had markedly lower serum SCT400 concentrations compared with those without or with a low tumor burden. Of the 9 assessable patients, 1 achieved complete response and 2 achieved partial responses. CONCLUSIONS SCT400 is well-tolerated and has encouraging preliminary efficacy in Chinese patients with CD20(+) B-cell NHL.
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Affiliation(s)
- Lin Gui
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Xiaohong Han
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Xiaohui He
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Yuanyuan Song
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Jiarui Yao
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Jianliang Yang
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Peng Liu
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Yan Qin
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Shuxiang Zhang
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Weijing Zhang
- Department of Lymphoma, the 307th Hospital of Chinese People's Liberation Army & the Affiliated Hospital of Military Medical Sciences, Beijing 100071, China
| | - Wenlin Gai
- Cell Culture Research and Development Center, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100176, China
| | - Liangzhi Xie
- Cell Culture Research and Development Center, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100176, China
| | - Yuankai Shi
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
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Dotson E, Crawford B, Phillips G, Jones J. Sixty-minute infusion rituximab protocol allows for safe and efficient workflow. Support Care Cancer 2015; 24:1125-9. [PMID: 26268782 DOI: 10.1007/s00520-015-2869-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/27/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Rituximab is a chimeric monoclonal antibody approved to treat B cell non-Hodgkin's lymphoma (NHL). Infusion reactions among NHL patients are common during the first exposure but decrease with subsequent infusions. We sought to assess the safety and feasibility of a rituximab rapid infusion protocol in the outpatient treatment area of a comprehensive cancer center. PATIENTS AND METHODS Patients with indolent and intermediate B cell NHL were invited to enroll in this prospective, single-institution study if they had received the first dose of rituximab according to the manufacturer-labeled standard titration schedule without grade >2 infusion reaction. The subsequent infusion proceeded without the use of steroid premedication at 100 mg/h administered over 15 min, with the remaining dose given over 45 min. Time savings between rapid infusion and standard titration were calculated. RESULTS Fifty patients received 60-min rituximab infusions during the second drug administration. No infusion-related reactions of any grade were observed with the rapid infusion protocol (0%, one-sided 97.5% CI 0-7.1%). The mean time for the rapid rituximab infusion was 62.4 min (95% CI 61.2-63.6). When compared to the standard second dose infusion recommendation, a mean time of 94.2 min (95% 90-98.4) was saved with rapid infusion. Nursing surveys demonstrated 100% satisfaction with the rapid infusion protocol. CONCLUSIONS Subsequent rituximab infusions can be safely administered over 60 min and without steroid premedication in an experienced outpatient infusion center when patients are appropriately screened. The faster infusions can reduce resource utilization and increase nursing satisfaction. TRIAL REGISTRATION NCT01206777.
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Affiliation(s)
- Emily Dotson
- The Ohio State Comprehensive Cancer Center-James Cancer Hospital, 460 W. 10th Ave., Columbus, OH, 43210, USA.
| | - Brooke Crawford
- Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Gary Phillips
- The Ohio State University Center for Biostatistics, Columbus, OH, USA
| | - Jeffrey Jones
- Department of Internal Medicine, Division of Hematology, The Ohio State Comprehensive Cancer Center-James Cancer Hospital, Columbus, OH, USA
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Abstract
Rituximab (a monoclonal antibody directed against CD 20) therapy can be acutely complicated by infusion reactions and cardiac arrhythmia on rare occasions. We report the first case of a new onset left bundle branch block (LBBB) after rituximab therapy for Wegener's vasculitis.
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Affiliation(s)
- Mujeeb Sheikh
- Department of Medicine, Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio, U.S.A
| | - Ankush Moza
- Department of Medicine, Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio, U.S.A
| | - Blair P Grubb
- Department of Medicine, Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio, U.S.A
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Swan JT, Zaghloul HA, Cox JE, Murillo JR. Use of a pharmacy protocol to convert standard rituximab infusions to rapid infusion shortens outpatient infusion clinic visits. Pharmacotherapy 2014; 34:686-94. [PMID: 24706572 DOI: 10.1002/phar.1420] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
STUDY OBJECTIVE To evaluate the impact of a pharmacy protocol that converts standard rituximab infusions to a rapid 90-minute infusion on the duration of outpatient infusion center clinic visits. DESIGN Prospective interventional study. SETTING Outpatient infusion clinic at an academic medical center. PATIENTS Sixty-four adults who received at least one rituximab infusion that was eligible for conversion to rapid infusion between August 2010 and July 2011 and who did not receive concurrent chemotherapy or colony-stimulating agents during the same clinic visit. Of the 64 patients, 37 received the rapid infusion (intervention cohort); 27 received the nonrapid infusion (control cohort). INTERVENTION Using a hospital-approved protocol, pharmacists converted rituximab infusions that met eligibility criteria (noninitial rituximab infusion, rituximab given in the previous 90 days, age 18 yrs or older, dose 375 mg/m(2) or less per infusion, dose 1000 mg or less per infusion, and no history of a grade 3 or higher reaction) to a rapid 90-minute infusion. MEASUREMENTS AND MAIN RESULTS The durations of rituximab infusion time and clinic visit time were evaluated and compared between the intervention cohort and the control cohort. Use of the pharmacy protocol to convert standard rituximab infusion to rapid rituximab infusion reduced infusion time by 110.5 minutes/infusion (median 94.5 min [interquartile range (IQR) 90-105 min] for rapid infusion vs 205 min [IQR 138-263 min] for nonrapid infusion; p<0.001) and reduced clinic visit time by 92 minutes/outpatient encounter (median 233 min [IQR 208-277] min for rapid infusion vs 325 min [IQR 275-415 min] for nonrapid infusion; p<0.001). This resulted in a reduction of the duration of outpatient clinic visits by an estimated 255-299 hours in 1 year. CONCLUSION Use of a pharmacist protocol that converted standard rituximab infusions to a rapid 90-minute infusion decreased the duration of outpatient infusion clinic visits for rituximab infusion.
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Affiliation(s)
- Joshua T Swan
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas; Department of Pharmacy Services, Houston Methodist Hospital, Houston, Texas; Center for Outcomes Research, Department of Surgery, Houston Methodist Research Institute, Houston, Texas
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11
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Rapid infusion rituximab for maintenance therapy: is it feasible? LEUKEMIA RESEARCH AND TREATMENT 2013; 2013:629283. [PMID: 24288618 PMCID: PMC3833187 DOI: 10.1155/2013/629283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 08/28/2013] [Indexed: 11/18/2022]
Abstract
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.
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Arredondo-Garza T, Majluf-Cruz A, Vela-Ojeda J, Mariscal-Ramírez I, Solis-Anaya L, Lopez-Gutiérrez JR, Guadarrama CH, Rico-Curiel E, Armenta-San Sebastián JA, Castañeda-Hernández G. Peri-infusional adverse reactions to rituximab in patients with non-Hodgkin's lymphoma. Arch Med Res 2013; 44:549-54. [PMID: 24120421 DOI: 10.1016/j.arcmed.2013.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 09/20/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS Rituximab is effective in the treatment of B-cell lymphoid malignances and some autoimmune diseases. Most patients receiving the first infusion of rituximab experience symptoms that decrease with subsequent infusions. It is assumed that the first dose of rituximab should be infused slowly during a 6-h period and during 4-h periods subsequently. The aim of the study was to evaluate the frequency and severity of adverse reactions to rituximab in patients with non-Hodgkin's lymphoma. METHODS This was an intensive pharmacovigilance prospective, observational, open labeled, multicenter cohort study conducted in 12 hospitals. Adults requiring treatment with rituximab (375 mg/m(2) body surface area) alone or with chemotherapy were included. Adverse reactions were graded according to the National Cancer Institute scale, whereas causality was established using the Naranjo algorithm. Infusions were classified as fast (0-90 min) and slow (>91 min). Fast infusions were used to analyze the associated adverse reactions. RESULTS We included 550 adult patients. Total infusion episodes were 1,749 and 52 adverse reactions were reported in 22 patients (4%). Thirty-one of 52 adverse reactions occurred during the first infusion. The risk of adverse reactions was lower with the fast infusions (10/52 adverse reactions [19.23%]). All adverse effects were mild. Twenty-three adverse effects were possibly related to rituximab. CONCLUSIONS Rituximab can be infused at a fast rate without an increase in adverse reactions. Peri-infusional adverse reactions are similar to those described for other populations but the incidence rate is lower. Rituximab has a favorable safety profile in patients with non-Hodgkin's lymphoma.
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Atmar J. Review of the safety and feasibility of rapid infusion of rituximab. J Oncol Pract 2013; 6:91-3. [PMID: 20592783 DOI: 10.1200/jop.200001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2009] [Indexed: 11/20/2022] Open
Abstract
Added to standard chemotherapy, rituximab improved survival in patients with non-Hodgkin's lymphoma; added to fludarabine-based regimens, it improved response and survival in patients with chronic B-cell lymphocytic leukemia.
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Affiliation(s)
- Jill Atmar
- Department of Lymphoma and Myeloma, The University of Texas M. D. Anderson Cancer Center, Houston, TX
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14
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Infusion Rate Escalation Study of Rituximab in Patients with CD20+ B-Cell Lymphomas: A Single Institution Analysis in Japan. ISRN ONCOLOGY 2013; 2013:863909. [PMID: 23691364 PMCID: PMC3649348 DOI: 10.1155/2013/863909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 02/28/2013] [Indexed: 11/19/2022]
Abstract
Background. To determine the maximum tolerable infusion rate of rituximab, and investigate the safety and feasibility of rapid infusion of rituximab for patients with CD20 positive B-cell lymphomas (CD20+NHL). Patients and Methods. 18 patients with CD20+NHL were registered. This study had six cohorts of administration rate of rituximab. The median age was 56 years (range, 38–79), and five of 18 patients were male. Two patients (11%) with diffuse large B-cell lymphoma were receiving R-CHOP therapy, two (11%) with indolent lymphoma were receiving R-CVP therapy, and 14 (78%) with indolent lymphoma were receiving rituximab as maintenance therapy. Results. A total of 88 cycles of rituximab was administered. Rapid infusion of rituximab was well tolerated, with only one grade 3 leukocytepenia and one grade 4 neutropenia. Four patients (22%) developed grade 1 infusion-related toxicities at the first administration of rituximab. No patient with severe drug-related events was observed.
Conclusions. We determined that the maximum tolerable infusion rate of rituximab is 300 mL/h (under 700 mg/h), and confirmed that administration of over 60 minutes is safe and feasible. We recommend rapid administration of rituximab for practice setting in patients with CD20+NHL being treated with rituximab or rituximab-containing chemotherapy. (Clinical trial no. JFCR2009-1027).
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Abstract
Rituximab has improved the treatment of B-cell non-Hodgkin lymphomas. While it is generally well tolerated, serious adverse effects including infusion reactions with hemodynamic compromise and cardiac arrhythmias or ischemia are possible. We report a case of coronary vasospasm occurring during a rituximab infusion in a patient with minimal tumour burden and who had no cardiac risk factors. This case highlights that determination of the cause of ischemia is important and may identify some patients who can be successfully rechallenged.
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Lang DSP, Hagger C, Pearson A. Safety of rapid rituximab infusion in adult cancer patients: a systematic review. Int J Nurs Pract 2011; 17:357-69. [PMID: 21781215 DOI: 10.1111/j.1440-172x.2011.01950.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study is to critically appraise, synthesize and present the best available evidence related to the safety of rapid rituximab infusion in adult non-Hodgkin lymphoma and chronic lymphocytic leukaemia patients. Data are from published and unpublished studies from electronic databases, grey literature and reference lists. The studies that met the inclusion criteria were critically appraised by two independent reviewers for methodological validity using standardized critical appraisal instruments. Proportional meta-analysis based on DerSimonian-Laird weights using a random effects model was used for statistical pooling through Stats Direct. Heterogeneity is assessed using Cochran Q. When statistical pooling is not possible, the findings were presented in narrative summary. Rapid rituximab infusion is safe for non-Hodgkin lymphoma patients at a 90 min regimen. However, there is insufficient evidence to support rapid rituximab infusions for chronic lymphocytic leukaemia patients.
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Affiliation(s)
- Dora S P Lang
- Singapore National University Hospital Centre for Evidence Based Nursing, Singapore.
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Larsen JL, Jacobsen S. Rapid infusion with rituximab: short term safety in systemic autoimmune diseases. Rheumatol Int 2011; 33:529-33. [PMID: 22068354 DOI: 10.1007/s00296-011-2208-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 10/22/2011] [Indexed: 10/15/2022]
Abstract
To describe the incidence, types and severity of adverse events, related to an accelerated regime of rituximab infusion in patients with various autoimmune diseases. Fifty-four patients with systemic autoimmune disease, to be treated with 1,000 mg of rituximab twice 2 weeks apart, participated. Pre-medication (oral prednisolone, anti-histamine and paracetamol) was administered 1-4 h before infusion start. The first infusion was administered over a period of 195 min. The second infusion over a period of 90 min. Any adverse events were classified using the Clinical Trials Classification of Adverse Events (CTCAE) v. 3.0. Ten patients (18.5%) experienced at least one infusion-related reaction (IRR) ever. The first infusion was associated with reactions in 4 CTCAE categories of which rhinitis were the most frequent. The CTCAE severity grading showed six patients (11.1%) had a grade 1 reaction. One patient (1.8%) had grade 2 events on both infusions and two patients (3.6%) had a grade 3 event on both infusions. RA patients more often had an infusion-related reaction (IRR) (9.2%) than the rest. The types of IRR were mostly of allergic or angio-oedematic nature. In practise, the rapid infusion was an easy to use regime and the second infusion is of time sparing significance to health professionals. No unexpected side effects were observed in relation to the accelerated regime.
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Affiliation(s)
- Janni Lisander Larsen
- Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
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Li Y, Huang S, Wang X, Zhou D, Huang K, Guo H, Fang J, Chen C, Liu Q. Rituximab combined with autologous peripheral blood stem cell transplantation improve therapeutic effects of chemotherapy in pediatric patients with Burkitt's lymphoma. J Trop Pediatr 2010; 56:337-41. [PMID: 20065046 DOI: 10.1093/tropej/fmp137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
We report on 2 children with Burkitt's lymphoma accompanied by extensive extranodal involvement treated with chemotherapy and Rituximab in combination with autologous peripheral blood stem cell transplantation (Auto-PBSCT) regimens. No obvious side effects could be seen during the Rituximab therapy. Both children achieved complete remission with no relapse after being followed up for 4.3 and 4 years, respectively. Our limited experience show that Rituximab in combination with chemotherapy and Auto-PBSCT might have better therapeutic effects on Burkitt's lymphoma of children and the side effects of Rituximab therapy is minimal and can be well tolerated.
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Affiliation(s)
- Yang Li
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
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19
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Abstract
Many cancer therapies administered by IV infusion, including monoclonal antibodies, have the potential for infusion reactions. All infusion reactions involve the immune system; however, some (anaphylactic) are allergic in nature and usually are mediated by immunoglobulin E (lgE), whereas others (anaphylactoid) are not true allergic reactions and are not mediated by lgE. Although reactions can be allergic or nonallergic, the clinical manifestations are the same and require prompt, accurate assessment and astute management to avoid severe adverse events, including fatality. Monoclonal antibodies have a unique side-effect profile that includes the potential for nonallergic infusion reactions caused by cytokine release. Understanding the pathophysiology underlying any infusion reaction will enhance decision making regarding rechallenge and thereby improve treatment outcomes. Rituximab is an example of a drug with the potential for varying types of infusion reactions. This article discusses oncology nurses' role in patient risk assessment, institution of prophylactic measures, administration monitoring, severity grading, management, and follow-up. This understanding will clarify new data regarding the safety of a rapid infusion schedule of rituximab.
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Affiliation(s)
- Wendy H Vogel
- Kingsport Hematology-Oncology Associates, Tennessee, USA.
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Chiang J, Chan A, Shih V, Hee SW, Tao M, Lim ST. A prospective study to evaluate the feasibility and economic benefits of rapid infusion rituximab at an Asian cancer center. Int J Hematol 2010; 91:826-30. [PMID: 20461562 DOI: 10.1007/s12185-010-0583-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 04/12/2010] [Accepted: 04/21/2010] [Indexed: 10/19/2022]
Abstract
Rituximab (Mabthera) is currently approved for the treatment of multiple subtypes of CD20-expressing, B-cell, non-Hodgkin's lymphoma. This study aimed to investigate whether rapid infusion of rituximab over 90 min is feasible without compromising patient's safety, and to reduce resource utilization at a cancer center. This is a prospective and open label study. Lymphoma patients who have received one cycle of rituximab without experiencing grade 3 or 4 infusional reaction were eligible for the rapid infusion of rituximab. Rapid infusion rituximab is infused over 90 min, with 20% of the dose given over the first 30 min and the remaining 80% over 60 min. A total of 79 patients were recruited for this study with a total of 269 infusions administered. Sixty-nine patients (87.3%) received rituximab in combination with chemotherapy. Average number of rituximab infusions administered to patients was 3.4 cycles. Rapid rituximab infusion schedule was well tolerated without any grade 3/4 infusion-related adverse events observed. An average amount of time saved per patient was 10.2 h. Rapid infusion rituximab over 90 min was well tolerated by patients, and shortened infusions have resulted in substantial reduction of resource utilization.
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Affiliation(s)
- Joen Chiang
- Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore
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21
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Provencio M, Sanchez A, Maximiano C, Cantos B, Méndez M, Bonilla F. A prospective study of left ventricle function after treatment with rapid-infusion Rituximab in patients with non-Hodgkin lymphoma. Leuk Lymphoma 2009; 50:1642-6. [PMID: 19757315 DOI: 10.1080/10428190903186478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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