Clinical Features of Rituximab-associated Gastrointestinal Toxicities

Abstract

Background: Rituximab is effective in treating several cancers. Little is known about gastrointestinal adverse events associated with rituximab. We describe the clinical, endoscopic, and histologic features of rituximab-associated colitis (RC) at a tertiary care cancer center. Methods: We conducted a retrospective study of cancer patients who had received rituximab and had undergone a colonoscopy between 2000 and 2018. Patients with competing etiologies for colitis were excluded. Results: Of the 13,717 patients who had received rituximab during the study period, 1660 had undergone colonoscopy. Among them, 70 (4%) had RC. Median time from rituximab treatment to RC onset was 181 days. Fifty-three patients had clinical gastrointestinal symptoms: 39 had diarrhea, 19 had abdominal pain, 11 had blood per rectum, and 5 had a concurrent fever. The median duration of symptoms was 21 days. Fifty patients (71%) received treatment for RC: immunosuppressive therapy in 12, antimicrobial agents in 21, antimotility agents in 42, and supportive care in 42. Nine patients had mucosal ulceration on endoscopy, and 52 had features of active inflammation on histology. Thirty-nine patients needed hospital admission, and 2 needed intensive care unit admission. One patient had colonic perforation that required surgical intervention. Patients who had abnormal endoscopic findings needed more frequent hospitalization (P=0.024) and more treatment for RC (P=0.001). Conclusions: RC is usually a mild disease requiring supportive care only. Nonetheless, on rare occasions, it can be severe enough to lead to colonic perforation and intensive care unit admission. Steroids used with the chemotherapeutic regimen can hamper RC severity.

Gastrointestinal perforation associated with novel antineoplastic agents: A real-world study based on the FDA Adverse Event Reporting System

“…The GIP of rituximab therapy is rare but there, and several case reports indicated a possible association between rituximab and GIP (54)(55)(56). Although rare, rituximab might be associated with colitis that can be severe enough to cause colon perforation (57). Noteworthy, axicabtagene ciloleucel, one of the CAR-T therapies, was detected with the potential GIP signals in our study.…”

Crohn’s Disease Following Rituximab Treatment for Follicular Lymphoma in a Patient with Synchronous Gastric Signet Ring Cells Carcinoma: A Case Report and Literature Review

“…RTX is usually well-tolerated but that adverse events can occur, such as severe mucocutaneous reactions, infusional reactions, progressive multifocal leukoencephalopathy, acute respiratory distress syndrome and cardiovascular events. Recently, RTX has also been associated with adverse gastrointestinal effects, including diarrhea and bowel perforation, and recent reports have associated RTX with the development of de novo IBD [4,5].…”

Hyperoxia combined with the B‐cell antagonist rituximab led to intestinal dysbiosis in neonatal mice

“…23,24 As an effective CD20 antagonist, rituximab impacts B cells in mucosa-associated lymphoid tissues as well as B-cell non-Hodgkin lymphoma. 24 Limited cases 25 have reported that rituximab can slightly injure digestion functions, such as dyspepsia and diarrhea. However, the cross-talking between intestinal B cells and gastrointestinal microbiota and rituximab still needs to be elucidated.…”