Rituximab, an anti-CD20
monoclonal antibody (mAb), is indicated in the treatment of B-cell non-Hodgkin
lymphomas, chronic
lymphoid leukemia, and
rheumatoid arthritis. The occurrence of infusion-related reactions (
IRR), especially during the first infusion, is one of the main concerns of
rituximab, otherwise well tolerated. Although
IRR are usually mild to moderate, fatal evolutions have been reported. These reactions are not specific to
rituximab and also observed with other compounds, including those recruiting effectors cells. Further studies are required to predict the frequency and severity of such reactions, to avoid life-threatening complications, especially in the first-in-human studies. Areas covered: This review reports data available to date on the occurrence of
IRR induced by
rituximab. Then, factors associated with
IRR are described, with proposed pathogenic mechanisms of
IRR. Finally, different methods to prevent and manage
IRR are reported. Expert opinion: Various factors have been associated with the occurrence and severity of
IRR. A predictive model of
IRR is of importance to prevent life-threatening
IRR or detrimental interruption of
rituximab therapy. This model would combine parameters, such as the number of CD20 positive cells and NK cells (CD16 positive), together with the level of CD20 and CD16 expressions, and FCGR3Apolymorphism.