title: Bone marrow involvement is predictive of infusion-related reaction during rituximab administration in patients with B cell lymphoma.
abstract: OBJECTIVE
  The purpose of this study is to evaluate risk factors for infusion-related reaction (IRR) following rituximab administration in patients with B cell non-Hodgkin lymphoma.
  
  
  METHODS
  A retrospective analysis was conducted of patients with newly diagnosed B cell lymphoma who have received rituximab-included immunochemotherapy with appropriate premedication and commonly used schedule of infusion rate. IRRs were graded by review of the patients' electronic medical record according to the Common Terminology Criteria for Adverse Events version 4.0.
  
  
  RESULTS
  One hundred and sixty-nine patients were included in the analysis and most of the patients (150; 88.8 %) had diffuse large B cell lymphoma (DLBCL). Thirty-six patients (21.3 %) had any grade of IRRs: 23 patients were grade (G) 1 (13.6 %), 13 had ≥G2 IRRs (7.7 %), and only 4 had ≥G3 IRRs (2.4 %). All except one patient had IRR during the first cycle and only two had repetitive IRR thereafter. Bone marrow (BM) involvement was the strongest risk factor for IRR in multivariable analysis (odds ratio 4.06, 95 % confidence interval 1.67-9.89; p = 0.002). A subgroup analysis confined to patients with DLBCL showed very similar results when compared with the entire population, and patients with DLBCL who had ≥G2 IRR showed shorter event-free and overall survival when compared to those who did not.
  
  
  CONCLUSIONS
  BM involvement is predictive of occurrence of IRR during rituximab administration in patients with B cell lymphoma. More intensive premedication and careful observation for IRR during rituximab administration are required for patients with B cell lymphoma who have BM involvement.
authors.affiliation: Division of Hematology & Medical Oncology, Department of Internal Medicine, Gachon University School of Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea.
authors.forename: Junshik
authors.initials: J
authors.lastname: Hong
authors.forename: Ji Yeon
authors.initials: JY
authors.lastname: Kim
authors.forename: Hee Kyung
authors.initials: HK
authors.lastname: Ahn
authors.forename: Sang-Min
authors.initials: SM
authors.lastname: Lee
authors.forename: Sun Jin
authors.initials: SJ
authors.lastname: Sym
authors.forename: Jinny
authors.initials: J
authors.lastname: Park
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Cho
authors.forename: Jeong Yeal
authors.initials: JY
authors.lastname: Ahn
authors.forename: Sanghui
authors.initials: S
authors.lastname: Park
authors.forename: Sang Pyo
authors.initials: SP
authors.lastname: Lee
authors.forename: Dong Bok
authors.initials: DB
authors.lastname: Shin
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols; D001853:Bone Marrow / Q000187:drug effects* / Q000473:pathology; D016001:Confidence Intervals; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000009:adverse effects*; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D016017:Odds Ratio; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D007155:Immunologic Factors; D000069283:Rituximab