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How it is administered
Rituximab is administered as an intravenous (IV) infusion. It is available in single-dose vials containing 10 mg/mL, which are diluted and given through a vein by a healthcare professional. The infusion is typically given in a hospital or clinic setting. For some patients, a subcutaneous (under the skin) version is available, but for large B cell lymphoma, the IV form is most commonly used.
The dosing schedule and number of infusions depend on the specific type of blood cancer being treated, the treatment regimen, and whether rituximab is being used alone or in combination with chemotherapy. For diffuse large B-cell lymphoma (DLBCL), rituximab is usually given in combination with chemotherapy (such as CHOP) every 21 days for up to 8 cycles.
How it works
Rituximab is a monoclonal antibody that specifically targets the CD20 protein found on the surface of B cells, which are a type of white blood cell involved in many blood cancers, including large B cell lymphoma. By binding to CD20, rituximab marks these cells for destruction by the immune system. The mechanisms by which rituximab kills B cells include complement-dependent cytotoxicity (CDC), where the body's complement system attacks the marked cells, and antibody-dependent cell-mediated cytotoxicity (ADCC), where immune cells recognize and destroy the targeted B cells.
In patients with blood cancers like large B cell lymphoma, abnormal B cells grow uncontrollably. By depleting these B cells, rituximab helps to control the disease. After treatment, B cell levels in the blood drop significantly and typically begin to recover within 6 to 12 months after therapy ends, although recovery may take longer in some patients.
Common side effects
Common side effects of rituximab in patients with large B cell lymphoma include:
- Infusion-related reactions (fever, chills, nausea, rash, low blood pressure)
- Infections (including serious bacterial, viral, or fungal infections)
- Fever
- Lymphopenia (low lymphocyte count)
- Neutropenia (low neutrophil count)
- Anemia
- Nausea
- Fatigue
- Cough
- Headache
- Muscle aches
- Low blood pressure
Serious side effects can include severe infusion reactions, severe skin and mouth reactions, reactivation of hepatitis B, progressive multifocal leukoencephalopathy (PML, a rare brain infection), tumor lysis syndrome, and bowel obstruction or perforation.
Who Should take it
Rituximab is indicated for adults with previously untreated diffuse large B-cell lymphoma (DLBCL), which is a common type of large B cell lymphoma. It is used in combination with chemotherapy regimens such as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or other anthracycline-based treatments.
Rituximab is also used for other blood cancers, including follicular lymphoma and chronic lymphocytic leukemia (CLL), as well as for some autoimmune diseases. In the context of large B cell lymphoma, it is most effective when given as part of a combination therapy for newly diagnosed patients. Your healthcare team will determine if rituximab is appropriate for you based on your diagnosis, overall health, and treatment goals.
Who should not take it
Rituximab should not be used in patients with a known severe allergic reaction (hypersensitivity) to rituximab or any of its components. There are no absolute contraindications listed, but caution is needed in patients with active, severe infections, as rituximab can further suppress the immune system.
Patients with a history of hepatitis B infection should be carefully evaluated and monitored, as rituximab can cause reactivation of hepatitis B, which may lead to serious liver problems. Live virus vaccines should not be given before or during rituximab treatment. Pregnant women should avoid rituximab due to potential harm to the fetus, and women of childbearing potential should use effective contraception during and for 12 months after treatment.
Commonly used with
Rituximab is most commonly used in combination with chemotherapy regimens for large B cell lymphoma. The most common combination is R-CHOP, which includes rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. It may also be used with other anthracycline-based regimens depending on the patient's specific disease and health status.
In some cases, rituximab may be used as maintenance therapy after initial treatment, especially in other types of lymphoma.
Commonly tested with
Rituximab has been tested in combination with various chemotherapy regimens, including CHOP and other anthracycline-based therapies, in clinical trials for large B cell lymphoma. It has also been studied in combination with fludarabine and cyclophosphamide for chronic lymphocytic leukemia (CLL), and with other agents for different types of blood cancers and autoimmune diseases.
In clinical practice, patients may have regular blood tests and imaging studies to monitor their response to rituximab and chemotherapy, as well as to check for side effects and complications.
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