Abstract
BackgroundRituximab (R) is a chimeric human-murine anti-CD20 monoclonal antibody used to treat B-cell lymphomas. Despite R remarkable activity against malignant cells, there are concerns that R may facilitate the occurrence of infections. This study is aimed to define risk factors for infections, and the potential interaction with time since therapy, in patients undergoing R containing regimens.MethodsThe study has been designed as a multiple failure events historical cohort including all patients who received a R contain regimen at London Royal Free Hospital between May 2007 and April 2009.ResultOne-hundred-eighty-one infections occurred among the 113 enrolled patients (overall incidence rate 3.30 per 1000 person-days). Multivariate analysis showed that lymphocyte counts at nadir, graft versus host disease, HIV sero-status and the type of malignancy were all independently associated with the risk of infection. In addition the analysis of the interaction with the time since the start of therapy provided evidence that different risk factors may increase risk of infections in different times.ConclusionThis study provides preliminary data to describe the association between several patients’ baseline characteristics and infections during therapy with R.
Highlights
Rituximab (R) is a chimeric human-murine anti-CD20 monoclonal antibody used to treat B-cell lymphomas
In a previous study [4] we highlighted that the addition of R to standard chemotherapy does not increase the risk of infections, we found a paucity of data about potential risk factors which may increase the risk of infections in selected groups of patients
The analysis provides moderate to strong evidence that all the 4 risk factors were associated with the infections in a time dependent manner; i.e.: HIV and type of diagnosis were associated with increased risk of infection in first six months only, graft-versus-host disease (GVHD) in the second and third time periods while counts of lymphocytes at nadir was associated with increased risk for all the 3 time periods
Summary
Rituximab (R) is a chimeric human-murine anti-CD20 monoclonal antibody used to treat B-cell lymphomas. Despite R remarkable activity against malignant cells, there are concerns that R may facilitate the occurrence of infections. Rituximab (R) is a chimeric human-murine monoclonal antibody used to treat CD20 positive malignancies and autoimmune diseases. It has been shown that R can deplete peripheral B cells while B-cell precursors and mature plasma cells remain unaffected [1]. This may explain the reversibility of R effects on the immune system and its limited effect against multiple myeloma [2]. R is widely used off-label to treat other conditions such as steroidrefractory chronic graft-versus-host disease (GVHD) [6,7]
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