Interstitial pneumonitis during rituximab-containing chemotherapy for non-Hodgkin lymphoma

Abstract

Rituximab is widely used for CD20+ non-Hodgkin lymphoma (NHL). The use of rituximab has been uncommonly associated with pulmonary toxicity. We report here a single institution experience on the clinical characteristics, diagnosis, treatment and outcome of rituximab-induced interstitial lung disease. From May 2007 to February 2008, 107 patients with NHL received rituximab-containing chemotherapy. Among them, nine patients were identified who developed interstitial pneumonitis during rituximab-containing chemotherapy. The median cycles of rituximab prior to presentation was two. Most of the patients manifested with high fever, while some had dyspnea or non-productive cough. Pulmonary diffuse interstitial infiltrations were seen on computed tomography scans of all the patients. Treatment consisted of glucocorticoids with a slow taper and antibiotics against atypical pulmonary pathogens. Eight patients responded to glucocorticoid therapy and recovered, whereas one died of secondary infection. Two of the four patients who were retreated with rituximab had recurrence of interstitial pneumonitis. In conclusion, clinicians should be highly alerted of the possibility of interstitial pneumonitis in NHL patients treated with rituximab-containing regimen. Early recognition, timely establishment of diagnosis and prompt treatment with glucocorticoids in combination with empirical antibiotics are essential for a favourable clinical outcome. Retreatment with rituximab and other cytotoxic agents known to cause pulmonary toxicity should be carefully considered for risk benefit ratio.

Rituximab-induced lung disease: a systematic literature review

“…Of the 45 patients, 17 (38%) were in Asia, 12 were in the Americas (and their ethnic origin was not reported) and 16 were in Europe. The rate of occurrence was 8.4% (nine out of 107) in the Korean case series [39] and 11% (four out of 36) in the Dutch case series [38]. The reason for rituximab therapy was diffuse large B-cell lymphoma in 30 patients, indolent lymphoma in 10 (mantle cell lymphoma (n52) [20,21,39], marginal zone lymphoma or mucosaassociated lymphoid tissue (MALT) (n53) [22,32,33], follicular lymphoma (n54) [24,32,39] and Waldenströ m's macroglobulinaemia (n51) [38]), chronic lymphocytic leukaemia in two [3,37], ITP in two [18,26] and RA in one [16].…”

“…1) [3,, described in anecdotal case reports and in nine case series reporting two cases [16,21,29,34,35], three cases [19,33], four cases [38] or nine cases [39]. A few adequately documented cases occurred during clinical trials.…”

Interstitial pneumonitis during rituximab-containing chemotherapy for primary central nervous system lymphomas: a case report and review of literature

“…According to Wagner's review, hypoxemia and saturation of blood oxygen decreasing is uniformly abnormal in RTX-ILD [14]. There's also research signify fever was the most common presenting symptom [15].…”

Female Pelvis: Genital Organs

“…It is therefore mainly used to treat non-Hodgkin lymphoma and chronic lymphocytic leukemia without compromising humeral immunity. Although the incidence of rituximab-induced interstitial lung disease was estimated to be very rare by the manufacturer (<0.03 %), more recent studies reported an incidence of 3.5-11 % Iu et al 2008 ;Nieuwenhuizen et al 2008 ). The CT pattern most often described is (sub)acute OP followed by NSIP (Lioté et al 2010 ).…”