Rituximab adverse effects

Adverse effects are usually infusion related, especially after the first infusion of rituximab. Adverse effects include fever, chills, respiratory... 

This hot antibody is linked to radioactive iodine and binds to the CD20 receptor present on B lymphocytes (see Rituximab above). Tositumomab has shown activity in non-Hodgkin s lymphoma. Hematologic toxicity occurs several weeks after administration and may persist for months. Since radioactive iodine may have adverse effects on the thyroid, all patients must receive thyroid-blocking agents. 

The addition of rituximab to chemotherapy has an adverse effect on outcome in this patient population. 

About 30% of patients develop rashes with the first 1000 mg treatment this incidence decreases to about 10% with the second infusion and progressively decreases with each course of therapy thereafter. These rashes do not usually require discontinuation of therapy although urticarial or anaphylactoid reactions, of course, preclude further therapy. Immunoglobulins (particularly IgG and IgM) may decrease with repeated courses of therapy and infections can occur, although they do not seem directly associated with the decreases in immunoglobulins. Rituximab has not been associated with activation of tuberculosis, nor with the occurrence of lymphomas or other tumors (see Chapter 55). Other adverse effects, eg, cardiovascular events, are rare. 

Most side effects are felt after the first treatment with rituximab and attention should be given to the rate of infusion. The most common immediate side effects of rituximab are fever, chills and respiratory symptoms, but these effects are much milder than the traditional chemotherapy. Other infusion reactions include nausea, angioedema, headache, hypotension, puritus, utricaria, rash and vomiting. The adverse effects decrease with each subsequent administration of the drug. Other side effects associated with rituximab include B-cell depletion, cytopenia, immuno-genicity and multiple pulmonary events. 

A wide range of adverse effects of ibritumomab has been reported. Most were hematological, thrombocytopenia being the most common, followed by a low hemoglobin and leukopenia. The most common non-hematological events were related to infusion and were similar to those reported with rituximab they included weakness (54%), nausea (35%), chills (15%), and fever (21%) (2,3). Infectious complications during treatment with ibritumomab are rare, pneumonia being the most common. There is no obvious hepatotoxicity. 

A variety of ocular adverse effects, including conjnnctivi-tis, transient ocular edema, and visnal changes, occnrred in 7% of patients receiving rituximab (11). 

In general, the MoAbs used in treating cancer are relatively well tolerated compared with conventional cytotoxic chemotherapy. The main adverse effect associated with rituximab use is infusion-related or hypersensitivity reactions. Patients may experience fever, rigors, dyspnea, hypotension, and rarely anaphylactoid reactions. Premedication with acetaminophen, diphenhydramine, and corticosteroids can reduce these reactions. Patients with significant tumor burden at the time of first treatment with rituximab may experience tumor lysis syndrome, and appropriate measures should be implemented to prevent this complication in these patients. 

Most of the adverse effects of rituximab are infusion related, particularly after the first infusion, and consist of fever, chills, respiratory symptoms, fatigue, headache, pruritus, and angioedema. Premedication with oral acetaminophen 650 mg and diphenhydramine 50 mg is usually given 30 minutes before rituximab infusion. 

Hematologic Rituximab can cause both neutropenia and thrombocytopenia [154 ]. The incidence of late-onset neutropenia is generally reported to be 3-27% [155 ]. In a large cohort of patients with newly diagnosed B cell lymphoma the incidence was 11% after front-line rituximab-based treatment. It occurred 66 days after the last course of the treatment, and the mean duration was 97 days. The FcyRIIIa polymorphism was highly associated with this adverse effect [156 ]. 

---