Abstract
IntroductionIntravascular large B-cell lymphoma is a rare aggressive disseminated disease characterized by the presence of lymphoma cells in small vessels without lymphadenopathy. Rituximab, a novel monoclonal antibody against the CD20 B-cell antigen, has been reported to be effective in treating intravascular large B-cell lymphoma. However, adverse events have been reported in association with rituximab infusion.Case presentationWe report the case of a 54-year-old Japanese man diagnosed with Asian variant intravascular large B-cell lymphoma who died within five hours of the initiation of a first course of chemotherapy including rituximab. Autopsy results suggested that the patient died of severe systemic inflammatory response syndrome. A literature review revealed that rituximab administered during the second course of chemotherapy (instead of during the first course) appears to reduce the incidence of infusion reactions (from 48% to 15%) without altering the frequency of complete remission outcomes.ConclusionsOur data indicate that the incidence of adverse reactions to rituximab can be markedly decreased if the tumor load is first reduced with an initial course of chemotherapy excluding rituximab. Future prospective studies of the timing of rituximab administration are warranted.
Highlights
Intravascular large B-cell lymphoma is a rare aggressive disseminated disease characterized by the presence of lymphoma cells in small vessels without lymphadenopathy
Our data indicate that the incidence of adverse reactions to rituximab can be markedly decreased if the tumor load is first reduced with an initial course of chemotherapy excluding rituximab
We here report a case of a patient diagnosed with Asian variant Intravascular large B-cell lymphoma (IVLBCL) who died from systemic inflammatory response syndrome (SIRS) during the first course of a chemotherapy regimen that included rituximab
Summary
This case report demonstrates that rituximab administration during the first course of chemotherapy can be extremely dangerous for IVLBCL patients. Our literature review indicates that the incidence of adverse reactions can be markedly decreased if the tumor load is first reduced with an initial course of rituximab-free chemotherapy followed by second or later courses of a rituximab-based regimen. These data have been derived from a small number of patients, and future prospective studies of the timing of rituximab administration are warranted. Author details 1Department of General Medicine, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo 164-8541, Japan. Author details 1Department of General Medicine, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo 164-8541, Japan. 2Department of Hematology, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo 164-8541, Japan. 3Department of Diagnostic Pathology, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo 164-8541, Japan
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