The late adverse events of rituximab therapy--rare but there!
Rituximab, an anti CD20 monoclonal antibody, has now become a cornerstone in the treatment of many CD20 positive hematological malignancies and a variety of autoimmune disorders. In contrast to the acute allergic and cytokine associated reactions, late adverse events of rituximab are indeed uncommon but at the same time probably under-reported. In this review, we detail late adverse events reported since its use in hemato-oncological neoplasias and other disorders. These adverse events include the development of late-onset neutropenia, defects of immune reconstitution with associated immune compromise, infections, progressive multifocal leukoencephalopathy, reactivation of hepatitis, intestinal perforation and interstitial pneumonitis. Possible mechanisms involved in rituximab-associated complications and the pathogenesis of these adverse effects are reviewed and discussed. Evidence based graded recommendations for the management of these adverse effects are proposed.
Ram
Ron
R
Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
Ben-Bassat
Isaac
I
Shpilberg
Ofer
O
Polliack
Aaron
A
Raanani
Pia
P
D000328:Adult; D000906:Antibodies / Q000737:chemistry; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000276:immunology; D000970:Antineoplastic Agents / Q000009:adverse effects*; D019337:Hematologic Neoplasms / Q000188:drug therapy* / Q000276:immunology; D006689:Hodgkin Disease / Q000188:drug therapy*; D006801:Humans; D007107:Immune System; D007167:Immunotherapy / Q000379:methods; D008223:Lymphoma / Q000188:drug therapy*; D008875:Middle Aged; D000069283:Rituximab; D013997:Time Factors
D000906:Antibodies; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000970:Antineoplastic Agents; D000069283:Rituximab