title: Pharmaceutical follow-up for patients on rituximab therapy for non-Hodgkin lymphoma: what is the evidence?
abstract: BACKGROUND
  Introduction of the monoclonal antibody rituximab to chemotherapy regimens has substantially improved disease-free and overall survival in patients with non-Hodgkin lymphomas (NHL). The short-term safety of this drug has been widely reported, but there are few data on long-term safety, which suggests that these patients require prolonged follow-up.
  
  
  OBJECTIVE
  To review the literature on follow-up models, with a focus on the safety of rituximab therapy for diffuse large B-cell lymphoma and follicular lymphoma.
  
  
  METHODS
  The Cochrane Library, Embassy, Lilacs, Medline, and Scirus databases were searched for systematic reviews and randomized controlled trials. Furthermore, textbooks and journals on pharmaceutical care and institutional websites were searched for patient management recommendations. The outcomes were follow-up models and grade 3, 4, and 5 adverse reactions.
  
  
  RESULTS
  Five systematic reviews and eight clinical trials or updates describing patient follow-up or reporting adverse reactions were identified. Only one systematic review and seven clinical trials reported follow-up routines for patients receiving rituximab, including information on staging, frequency of reassessment, and laboratory tests, as well as pre-infusion care and management of acute or delayed adverse reactions. Five systematic reviews and four clinical trials reported data on statistically significant adverse reactions (fever, leukopenia, infection). Four guidelines or institutional protocols for treatment and follow-up were identified, as well as seven studies describing experiences in the implementation of pharmaceutical care for oncology patients, but none were specifically focused on follow-up of patients receiving rituximab for NHL.
  
  
  CONCLUSIONS
  Although some systematic reviews and clinical trials contain guidance on follow-up of patients receiving rituximab for NHL, there are no validated strategies for systematic follow-up of these patients with a focus on safety. As there are few data on long-term safety profile of these novel treatments, monitoring strategies should be developed and implemented to ensure safe and optimized use of drugs recently added to the therapeutic arsenal of clinical oncology.
authors.affiliation: Grupo Hospitalar Conceição, Ave. Francisco Trein, 596, Porto Alegre, Rio Grande do Sul, Brazil. vanessa.hegele@gmail.com
authors.forename: Vanessa
authors.initials: V
authors.lastname: Hegele
authors.forename: Paula
authors.initials: P
authors.lastname: Stoll
authors.forename: Diego
authors.initials: D
authors.lastname: Wüst
authors.forename: Guilherme
authors.initials: G
authors.lastname: Ehrenbrink
authors.forename: Luiza Raquel
authors.initials: LR
authors.lastname: Grazziotin
authors.forename: Juliana Prohonoski
authors.initials: JP
authors.lastname: Caregnato
authors.forename: Luciane Pereira
authors.initials: LP
authors.lastname: Lindenmeyer
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016903:Drug Monitoring / Q000379:methods; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000473:pathology; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D000069283:Rituximab; D013997:Time Factors
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab