How it is administered

Rituximab is given as an intravenous (IV) infusion, meaning it is slowly injected into a vein over a period of time. It is not given as a quick injection (push or bolus). The medication comes in single-dose vials and is diluted before administration.

For Burkitt Lymphoma and other mature B-cell non-Hodgkin lymphomas in children and adults, rituximab is typically given in combination with chemotherapy. The dosing schedule and number of infusions depend on the specific treatment plan. In pediatric patients, rituximab is given as part of a multi-drug chemotherapy regimen, with a total of six infusions during induction and consolidation phases.

Premedication with acetaminophen and an antihistamine is recommended before each infusion to reduce the risk of infusion-related reactions. The infusion rate is started slowly and increased gradually if no reactions occur.

How it works

Rituximab is a monoclonal antibody that targets a protein called CD20, which is found on the surface of certain B-cells, including the cancerous B-cells in Burkitt Lymphoma. When rituximab binds to CD20, it helps the immune system recognize and destroy these B-cells.

The destruction of B-cells happens through several mechanisms, including direct cell killing, activation of the immune system to attack the cells, and triggering complement proteins that help break down the targeted cells. By depleting abnormal B-cells, rituximab helps control the growth and spread of lymphoma.

In patients with blood cancers like Burkitt Lymphoma, rituximab can lead to a rapid reduction in the number of circulating and tissue-based B-cells. This effect is usually sustained for several months, and normal B-cell levels typically recover within a year after treatment is completed.

Who Should take it

Rituximab is indicated for patients with certain types of blood cancers, including Burkitt Lymphoma, diffuse large B-cell lymphoma (DLBCL), and other mature B-cell non-Hodgkin lymphomas. It is approved for use in both adults and children (aged 6 months and older) with previously untreated, advanced-stage, CD20-positive Burkitt Lymphoma, Burkitt-like lymphoma, or mature B-cell acute leukemia, in combination with chemotherapy.

Rituximab may also be used in other CD20-positive B-cell malignancies, such as follicular lymphoma and chronic lymphocytic leukemia, as well as in some autoimmune diseases. The decision to use rituximab should be made by a healthcare provider based on the type of cancer, stage, and individual patient factors.

Who should not take it

There are no absolute contraindications listed for rituximab, but it should not be used in patients with known severe allergic reactions to rituximab or any of its components.

Rituximab should be used with caution in patients with active, severe infections, as it can increase the risk of serious infections. It is not recommended for use in patients with severe, active infections or those who have not been screened for hepatitis B, as reactivation of hepatitis B can occur. Live virus vaccines should not be given before or during rituximab treatment. Pregnant women should avoid rituximab due to the risk of harm to the fetus.

Commonly used with

Rituximab is most commonly used in combination with chemotherapy drugs for the treatment of Burkitt Lymphoma and other B-cell lymphomas. In pediatric patients, it is combined with multi-agent chemotherapy regimens such as LMB (Lymphome Malin B) protocols, which include drugs like cyclophosphamide, vincristine, prednisone, doxorubicin, methotrexate, cytarabine, and etoposide.

Premedications such as acetaminophen, antihistamines, and sometimes corticosteroids are given before rituximab infusions to reduce the risk of infusion reactions.

Commonly tested with

Rituximab has been tested in clinical trials in combination with various chemotherapy regimens for Burkitt Lymphoma and other blood cancers. In pediatric Burkitt Lymphoma, it is tested with LMB chemotherapy protocols, which include cyclophosphamide, vincristine, prednisone, doxorubicin, methotrexate, cytarabine, and etoposide.

In adults, rituximab is often tested with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or other anthracycline-based chemotherapy regimens. It has also been studied with fludarabine and cyclophosphamide in chronic lymphocytic leukemia.