Fatal Pneumocystis pneumonia following rituximab administration for rheumatoid arthritis

Teichmann, Lino L.; Woenckhaus, Matthias; Vogel, C.; Salzberger, Bernd; Schölmerich, J

doi:10.1093/rheumatology/ken234

Cited by 59 publications

(30 citation statements)

References 9 publications

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“…However, the dose-dense rituximab employed in the R-CHOP-14 regimen might also contribute to this risk [15]. Indeed, rituximab administration has been recently suggested to induce, both in vitro and in vivo, a dose-dependent T cell inactivation, resulting in decreased interferon gamma secretion and the T cell proliferation capacity against different stimuli, including infective agents [16,17,18]. In fact, according to published reports, the risk for PJP in patients receiving the R-CHOP therapy was not related exclusively to the number of CD4 T cells [19], confirming a potential contribution of T cell functional impairment and/or dysfunction of other cellular components to the development of PJP [20,21].…”

Section: Discussionmentioning

confidence: 99%

The Increased Risk for Pneumocystis Pneumonia in Patients Receiving Rituximab-CHOP-14 Can Be Prevented by the Administration of Trimethoprim/Sulfamethoxazole: A Single-Center Experience

et al. 2011

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Recent studies suggest an increased risk for Pneumocystis jirovecii pneumonia (PJP) in adults receiving short-interval rituximab-CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) therapy for diffuse large cell B cell lymphoma (DLBCL). This retrospective study evaluates precise PJP incidence and the efficacy of anti-PJP prophylaxis in DLBCL. Patients with DLBCL, aged ≧18 years and treated between December 2004 and December 2010, were included. Details of treatment-related respiratory infections, focusing on PJP incidence, risk factors and prophylaxis, were assessed. A total of 132 patients were analyzed; 47 were treated with rituximab-CHOP therapy every 21 days (R-CHOP-21) and 85 were treated every 14 days (R-CHOP-14). The incidence of treatment-related respiratory infections was higher in patients receiving R-CHOP-14. PJP was diagnosed in 5 patients: 4 in the R-CHOP-14 (6.6%) and 1 in the R-CHOP-21 cohort (2.6%), using triplex polymerase chain reaction (PCR) for PJ in bronchoalveolar fluid. None of the patients receiving P.jirovecii prophylaxis (n = 33) developed PJP, compared with 6.6% of those treated with R-CHOP-14 without such prophylaxis. An older age and R-CHOP administered every 14 rather than every 21 days increased the PJP risk. Trimethoprim/sulfamethoxazole prophylaxis is found to be highly efficient in preventing this life-threatening complication and, therefore, should be recommended for patients receiving the R-CHOP-14 regimen.

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Section: Discussionmentioning

confidence: 99%

The Increased Risk for Pneumocystis Pneumonia in Patients Receiving Rituximab-CHOP-14 Can Be Prevented by the Administration of Trimethoprim/Sulfamethoxazole: A Single-Center Experience

et al. 2011

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“…This risk appears to be heightened when an intensive schedule of rituximab is employed, so prophylactic antibiotics have been suggested in that setting [11]. However, case reports have even described the association of the use of rituximab as a single agent and the development of PCP [12][13][14]. Taking this into consideration, it is hard to exclude the possibility that rituximab may contribute to the risk of PCP development, when used in the context of a steroid-dense R-CHOP-14 schedule.…”

mentioning

confidence: 99%

A resurgence ofPneumocystisin aggressive lymphoma treated with R-CHOP-14: the price of a dose-dense regimen?

Tadmor

McLaughlin

Polliack³

2010

Leukemia & Lymphoma

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“…While RTX has been used in clinical settings for over 10 years for hematological malignancies, it can lead to rare but lethal adverse events, such as progressive multiple leukoencephalopathy, interstitial pneumonia, ulcerative colitis, and P. jirovecii pneumonia [34,35,36]. The most severe adverse effect reported to date is lung damage, particularly a pulmonary hemorrhage leading to death [37].…”

Section: Discussionmentioning

confidence: 99%

Novel Use of Rituximab for Steroid-Dependent Nephrotic Syndrome in Children

et al. 2013

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Background: Though rituximab (RTX) is effective for childhood steroid-dependent nephrotic syndrome (SDNS), an established regimen does not exist. The relapses tend to occur when the peripheral blood B-cell count re-arises at 3 months upon single RTX infusion. This study was conducted to clarify whether the long-term remission of SDNS can be obtained by repeated RTX administrations. Methods: RTX was administered 4 times at 3-month intervals at 375 mg/m²/time to 5 children with SDNS. The changes in the clinical indicators were analyzed. Results: The median (range) observation period was 6.3 (0.9-8.4) years before RTX and 3.2 (1.9-3.8) years following the commencement of RTX. The changes in the clinical indicators were as follows (median and range): (1) annual number of relapses: before administration 1.4 (1.1-3.5) times/year, after administration 0.0 (0.0-0.0) times/year, and (2) median steroid dosage: before administration 0.80 (0.23-0.96) mg/kg/day, after administration 0.00 (0.00-0.00) mg/kg/day. All changes were significant at p < 0.05. Relapse occurred 3 times following the start of RTX (the period to relapse was 2.2, 1.9, and 2.3 years, respectively). No serious side effects were seen. Conclusions: Repeated RTX against SDNS in children may be a useful therapeutic option.

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Fatal Pneumocystis pneumonia following rituximab administration for rheumatoid arthritis

Cited by 59 publications

References 9 publications

The Increased Risk for Pneumocystis Pneumonia in Patients Receiving Rituximab-CHOP-14 Can Be Prevented by the Administration of Trimethoprim/Sulfamethoxazole: A Single-Center Experience

The Increased Risk for Pneumocystis Pneumonia in Patients Receiving Rituximab-CHOP-14 Can Be Prevented by the Administration of Trimethoprim/Sulfamethoxazole: A Single-Center Experience

A resurgence ofPneumocystisin aggressive lymphoma treated with R-CHOP-14: the price of a dose-dense regimen?

Novel Use of Rituximab for Steroid-Dependent Nephrotic Syndrome in Children

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