Rituximab Infusion in 30 Minutes’ Is Safe and Improves the Flow of Outpatients with Lymphoma Treatment (SPEEDR)

Abstract

Rituximab is a chimeric monoclonal antibody approved to treat B cell non-Hodgkin's lymphoma. Infusion reactions among patients are common during the first exposure but decrease with subsequent infusions. During the COVID-19 pandemic, there was an urgent need to avoid crowding of patients at our outpatient clinic at Karolinska University Hospital. We therefore introduced a new schedule for rapid IV infusion of 30 minutes of rituximab (SPEEDR) to patients who had well tolerated at least one dose of IV rituximab given in 90 minutes. We here present a retrospective analysis of tolerance and side effects for patients treated between January 2021 and December 2021. Ninety-nine patients received a total of 190 doses of rapid 30 minute infusion of rituximab. Fifty eight (59%) were male and the median age of our patients was 73 years. The patients had different types of lymphoid malignances and the most common diagnoses were diffuse large B-cell lymphoma (DLBCL, 38%), follicular lymphoma (FL, 21%) and marginal zone lymphoma (MZL, 11%). Thirty-four patients received single-agent rituximab treatment whereas 65 received rituximab in combination with chemotherapy. The 30 minute infusion was given after a preceding well-tolerated 90 minute dose. All doses thereafter were administrated in 30 minutes if no adverse events > grades 1 were seen. Rituximab was diluted in 500 ml 0.9% sodium chloride and infused in 30 minutes IV with a steady infusion rate without ramp up. The treating nurse measured blood pressure and pulse before starting the infusion and after completed infusion for all patients. Temperature was monitored before starting infusion and if the patient felt any discomfort during treatment or after. Data on infusion reactions, blood pressure, temperature and pulse were extracted from each patient's journal. Statistical analysis was performed using STATA. During the study period only 3 patients experienced an infusion reaction during or after the 30 minute infusion. No reaction was more than grade 2 and all patients responded well to standard treatment with fluids and could complete the rituximab infusion. Two of the patients who had an adverse event had not received any steroids before rituximab, one was treated with R-CHOP and had ingested 100 mg prednisone as part of the regimen. Analysis of median values before and during infusion for pulse was 70 vs 71.5 BPM (p=0.16), blood pressure 119/71 vs 119/70 (p= 0.08) mm Hg. Given the long serum half time of rituximab, the rapid SPEEDR infusion is highly unlikely to have negative effects on efficacy. We conclude that rituximab given as a 30-minute IV infusion is feasible and safe for patients with lymphomas who have previously tolerated a 90 minute infusion. This is an efficient way to optimize work flow in the outpatient clinic and to give cost-effective treatment to lymphoma patients.