Rituximab tolerability when given before or after CHOP.

Abstract

STUDY OBJECTIVE:

To determine the tolerability of rituximab, specifically cytokine release syndrome/acute infusion reactions (CRS), when it is administered before or after cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy in patients with non-Hodgkin's lymphoma (NHL).

METHODS:

This study is a retrospective analysis of patients identified through pharmacy chemotherapy records. Inclusion criteria were diagnosis of NHL, first cycle of rituximab with CHOP or modified CHOP (mCHOP), treated between 1/1/04 and 6/30/09, age 18 years and greater, and inpatient status. Patients were excluded if their records/information were unavailable. Patients were divided into two groups based on practices observed at our institution: rituximab followed by CHOP (R-CHOP) or CHOP followed by rituximab (CHOP-R). Patient records were reviewed to determine demographic data, CRS, vital signs, evidence of chills/rigors, use of rescue medications, and rituximab infusion rates.

RESULTS:

One-hundred thirteen patients meeting the inclusion criteria were divided into two groups: R-CHOP (n=29) and CHOP-R (n=84). R-CHOP patients experienced numerically more CRS (65.5% vs. 42.9%, p=0.0517) and significantly more chills/rigors (p=0.0376). Maximum and minimum oxygen (O(2)) saturations were significantly lower in the R-CHOP group (p=0.0444 and 0.0165, respectively). Maximum temperature was significantly higher in the R-CHOP group (p=0.0047). There was no difference between groups in use of rescue medications (p=1). R-CHOP patients required significantly more rate reductions (p=0.0431) than CHOP-R patients, although there was no difference in final tolerated rate between groups.

CONCLUSIONS:

Patients with NHL who receive rituximab after CHOP experience significantly fewer chills/rigors, higher oxygen saturations, lower maximum temperatures, and fewer rate reductions than patients who receive rituximab before CHOP.

• Authors: Idan S Hannawa, Daniel J Bestul
• Journal: Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners (J Oncol Pharm Pract) Vol. 17 Issue 4 Pg. 381-6 (Dec 2011) ISSN: 1477-092X [Electronic] England
• PMID: 21109616 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• Rituximab
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Prednisone

Topics

• Aged
• Aged, 80 and over
• Antibodies, Monoclonal, Murine-Derived (administration & dosage, adverse effects)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage)
• Chills (chemically induced, epidemiology)
• Cyclophosphamide (administration & dosage)
• Doxorubicin (administration & dosage)
• Drug Administration Schedule
• Female
• Fever (chemically induced, epidemiology)
• Humans
• Lymphoma, Non-Hodgkin (drug therapy, epidemiology)
• Male
• Middle Aged
• Prednisone (administration & dosage)
• Retrospective Studies
• Rituximab
• Treatment Outcome
• Vincristine (administration & dosage)