Rapid Infusion of Rituximab with or without Steroid Containing Chemotherapy. A Single Centre Experience.

Introduction: Infusion-related toxicity is frequent after the administration of Rituximab despite the fact that strict guidelines have been recommended. Recently, a rapid rituximab infusion schedule in combination with a steroid containing chemotherapy regimen was well tolerated and safe.

Purpose: To investigate the feasibility of a rapid infusion of rituximab with or without steroid containing chemotherapy.

Methods: Inclusion criteria: lymphoproliferative disorder CD20+ and having been treated with a first infusion of rituximab according to the product monograph. Exclusion criteria: lymphocytosis > 5 x 10⁹/L, toxicity grade 3/4 in the previous infusion of rituximab or dose > 375 mg/m². Schedule: First infusion of rituximab according to the product monograph; Further infusions over a total time of 90 minutes (20% in the first 30 minutes and the remaining 80% over 60 minutes). Premedication: acetaminophen and diphenhidramine, plus methylprednisolone only in those patients receiving steroid containing chemotherapy.

Results: A total of 50 patients were treated for a total of 165 infusions. Patient characteristics: median age 62 yr (range 28–83), 49 % males, DLBCL 36%, follicular 47%, mantle 6%, MALT 7%, other 4%. Chemotherapy regimens: R-CHOP 28%, R-EPOCH 9%, R-ESHAP 4%, R-other chemotherapy 8%, rituximab monotherapy 10%, rituximab maintenance 41%. Number of rituximab administrations with and without steroids: 68 and 97 infusions, respectively. Median time from previous rituximab infusion was 29 days (range 7–272). Sixteen rapid infusions were administered with an interval greater than 90 days from the previous standard infusions. This rapid rituximab administration schedule was very well tolerated. No grade 3/4 adverse events were seen. Two patients referred symptoms during rituximab infusion (both grade 1): abdominal discomfort that disappeared spontaneously and sore throat that required to slow down the infusion speed. All these reactions occurred in patients who did not receive premedication with steroids.

Conclusions: Rituximab administration in a 90-minute infusion schedule is well tolerated and safe in this group of patients. This approach is beneficial, both in patients who are administered steroids and in patients who are not.