Rituximab-induced lung disease: a systematic literature review

Abstract

The anti-CD20 antibody rituximab has been reported to induce a heterogeneous spectrum of lung disorders. The aim of the present study was to critically review data on the clinical presentations, causality assessments and management strategies of lung diseases possibly related to rituximab.A systematic literature review was performed on English-language reports in PubMed until September 2008.Cases of lung diseases ascribed to rituximab (n545) were identified, with three time-to-onset patterns. The most common presentation was acute/subacute hypoxaemic organising pneumonia (n537), starting 2 weeks after the last infusion (often around the fourth cycle) and resolving, in most cases, provided glucocorticoid therapy was given early. Acute respiratory distress syndrome occurred in five patients, within a few hours and usually after the first infusion. In the remaining three patients, macronodular organising pneumonia developed insidiously long after rituximab therapy and responded to steroids. Eight patients died. Based on time to onset, symptoms, and responses to discontinuation and rechallenge with rituximab and other drugs, 13 cases were highly compatible and 32 compatible with rituximab-induced lung disease.Knowledge of these presentations of rituximab-induced lung disease should prove helpful for diagnosis and causality assessment purposes. Time-to-onset data, suggesting different pathogenic mechanisms, support closer clinical and perhaps radiological monitoring between infusions, particularly in patients with a history of reversible respiratory symptoms.

Rituximab-induced pneumonitis mimicking miliary tuberculosis

“…Other presentations include diffused alveolar patterns (9%) and macronodules (3%) [2]. However, ILD with diffused pulmonary micronodules was found in our patient and was never reported.…”

“…Mechanisms leading to late-onset ILD remain unclear. A potential explanation may be the induction and release of cytokines following rituximab binding to CD20 + cells [2,4]. Because the patient was treated concomitantly with cytotoxic drugs, we recognise that it is difficult to completely rule out cytotoxic FIGURE 1 Chest computed tomography scan revealing diffused micronodules over bilateral lung field.…”

“…Rituximab is considered to be a relatively safe drug but recently, severe and fatal interstitial lung disease (ILD) was noted with an occurrence rate of 0.01-0.03% [2]. Computed tomography (CT) patterns of rituximabinduced ILD include focal (54%) or diffused (9%) alveolar patterns and macronodules (3%), or groundglass patterns (34%) [2]. In this regard, we report a patient with NHL in whom ILD developed after six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) therapy with diffused micronodules mimicking miliary tuberculosis (TB).…”

“…Rituximab is considered to be a relatively safe drug but recently, severe and fatal interstitial lung disease (ILD) was noted with an occurrence rate of 0.01-0.03% [2]. Computed tomography (CT) patterns of rituximabinduced ILD include focal (54%) or diffused (9%) alveolar patterns and macronodules (3%), or groundglass patterns (34%) [2].…”

Female Pelvis: Genital Organs

“…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 ).…”