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How it is administered
Rituximab is given as an intravenous (IV) infusion, meaning it is slowly injected into a vein over several hours. The dose and schedule depend on the specific type of blood cancer being treated and whether it is being used alone or with chemotherapy. For most blood cancers, including marginal zone lymphoma (a type of non-Hodgkin's lymphoma), the typical dose is 375 mg/m², given once weekly for several weeks or in cycles with chemotherapy. The first infusion is given slowly to monitor for reactions, and subsequent infusions may be given more quickly if tolerated.
There are also subcutaneous (under the skin) formulations available (such as rituximab and hyaluronidase), but these are only used after the first dose is given intravenously and are not interchangeable with the IV form without medical guidance.
How it works
Rituximab is a monoclonal antibody that targets a protein called CD20 found on the surface of B-cells, which are a type of white blood cell involved in many blood cancers, including marginal zone lymphoma. By binding to CD20, rituximab marks these cells for destruction by the immune system. This process leads to the depletion of abnormal B-cells, helping to control the growth and spread of the lymphoma.
The destruction of B-cells occurs through several mechanisms: it can trigger the immune system to attack and kill the cells (antibody-dependent cell-mediated cytotoxicity), activate a part of the immune system called complement (complement-dependent cytotoxicity), or directly cause the cells to die (apoptosis). Over time, normal B-cells can recover after treatment, but the cancerous B-cells are preferentially targeted and reduced.
Common side effects
- Infusion-related reactions (fever, chills, nausea, rash, low blood pressure, difficulty breathing)
- Fever
- Lymphopenia (low white blood cell count)
- Chills
- Infections
- Fatigue (asthenia)
- Nausea
- Headache
- Low blood cell counts (neutropenia, anemia, thrombocytopenia)
Serious but less common side effects can include severe infections, severe skin reactions, heart problems, kidney problems, and bowel obstruction or perforation. Most infusion reactions occur during the first infusion and decrease with subsequent doses.
Who Should take it
Rituximab is indicated for adults with several types of blood cancers, including non-Hodgkin's lymphomas such as marginal zone lymphoma, follicular lymphoma, and diffuse large B-cell lymphoma, as well as chronic lymphocytic leukemia (CLL). It can be used alone or in combination with chemotherapy, depending on the specific diagnosis and treatment plan.
For marginal zone lymphoma, rituximab may be used as a single agent in patients who have relapsed or are refractory (not responding) to other treatments, or in combination with chemotherapy as part of initial therapy. It is also used as maintenance therapy to help keep the cancer in remission after successful initial treatment.
Who should not take it
Rituximab should not be used in patients who have had a severe allergic or hypersensitivity reaction to rituximab or any of its components. It should also be avoided in patients with active, severe infections, as it can further suppress the immune system and increase the risk of complications.
Patients with a history of hepatitis B infection need careful screening and monitoring, as rituximab can cause reactivation of the virus, which can be life-threatening. Rituximab is not recommended for use during pregnancy or breastfeeding, as it may harm the developing baby or infant. Always inform your healthcare provider about your medical history before starting rituximab.
Commonly used with
Rituximab is often used in combination with chemotherapy regimens for blood cancers. For marginal zone lymphoma and other non-Hodgkin's lymphomas, it is commonly combined with chemotherapy drugs such as cyclophosphamide, vincristine, and prednisone (CVP), or with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone). In chronic lymphocytic leukemia, it is used with fludarabine and cyclophosphamide (FC).
It may also be used as maintenance therapy after initial treatment to prolong remission.
Commonly tested with
Rituximab has been tested in clinical trials with various chemotherapy regimens, including CVP, CHOP, and bendamustine for lymphomas, and with fludarabine and cyclophosphamide for CLL. It is also studied in combination with other targeted therapies and as maintenance therapy after initial treatment.
In clinical studies for marginal zone lymphoma and other indolent lymphomas, rituximab has been compared as a single agent versus in combination with chemotherapy, and as maintenance therapy versus observation after initial response.
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