Common brand names

• Riabni
• Rituxan
• Ruxience
• Truxima

How it is administered

Rituximab is given as an intravenous (IV) infusion, meaning it is slowly injected into a vein by a healthcare professional. It comes in single-dose vials and is diluted before administration. The dose and schedule depend on the specific blood cancer being treated, such as non-Hodgkin’s lymphoma (NHL), chronic lymphocytic leukemia (CLL), or other approved conditions. For blood cancers, the typical dose is 375 mg/m², administered on specific days in combination with chemotherapy or as a single agent. The first infusion is given slowly and may take several hours, while subsequent infusions may be given more quickly if the first is well tolerated. Premedication with acetaminophen and an antihistamine is recommended to reduce the risk of infusion reactions.

How it works

Rituximab is a monoclonal antibody that targets a protein called CD20, which is found on the surface of certain B-cells (a type of white blood cell). By binding to CD20, rituximab marks these cells for destruction by the body’s immune system. The destruction of B-cells is achieved through several mechanisms, including complement-dependent cytotoxicity (CDC) and antibody-dependent cell-mediated cytotoxicity (ADCC). This process leads to a reduction in abnormal B-cells, which are often the source of cancer in conditions like mantle cell lymphoma, other non-Hodgkin’s lymphomas, and CLL.

After treatment, B-cell levels in the blood drop significantly and can remain low for several months, gradually returning to normal over time. By targeting B-cells, rituximab helps control the growth and spread of blood cancers, improving outcomes when used alone or in combination with chemotherapy.

Who should take it

Rituximab is indicated for adults (and some pediatric patients) with certain blood cancers, including:

• Non-Hodgkin’s lymphoma (NHL), especially follicular lymphoma and diffuse large B-cell lymphoma (DLBCL), either as a single agent or in combination with chemotherapy.
• Chronic lymphocytic leukemia (CLL), in combination with chemotherapy (fludarabine and cyclophosphamide).
• Mantle cell lymphoma is a type of NHL, and rituximab is often used as part of combination therapy for this disease.

Patients may receive rituximab as part of their initial treatment, for relapsed or refractory disease, or as maintenance therapy to help prevent recurrence after successful initial treatment. Your doctor will determine if rituximab is appropriate based on your specific diagnosis, stage of disease, and overall health.

Who should not take it

Rituximab should not be used in patients who have had a 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.
• Severe, uncontrolled heart or lung disease.
• A history of hepatitis B infection (must be screened before starting treatment, as rituximab can cause reactivation).

Pregnant women should avoid rituximab, as it can harm the fetus. Women of childbearing age should use effective contraception during treatment and for 12 months after the last dose. Rituximab is not recommended for use with live vaccines before or during treatment.

Commonly used with

Rituximab is often used in combination with chemotherapy drugs such as:

• CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)
• CVP (cyclophosphamide, vincristine, prednisone)
• Fludarabine and cyclophosphamide (for CLL)

It may also be used with other targeted therapies or as maintenance therapy after initial treatment. Your doctor will select the best combination based on your specific cancer type and health status.

Commonly tested with

Rituximab has been tested in clinical trials with various chemotherapy regimens, including CHOP, CVP, fludarabine/cyclophosphamide, and others. It is also studied in combination with newer targeted therapies and as maintenance therapy after initial chemotherapy. In mantle cell lymphoma and other blood cancers, rituximab is a standard part of many combination regimens tested in clinical studies.