Treatment strategy for reducing the risk of rituximab-induced cytokine release syndrome in patients with intravascular large B-cell lymphoma: a case report and review of the literature

Abstract

IntroductionIntravascular large B-cell lymphoma is a rare aggressive disseminated disease characterized by the presence of lymphoma cells in small vessels without lymphadenopathy. Rituximab, a novel monoclonal antibody against the CD20 B-cell antigen, has been reported to be effective in treating intravascular large B-cell lymphoma. However, adverse events have been reported in association with rituximab infusion.Case presentationWe report the case of a 54-year-old Japanese man diagnosed with Asian variant intravascular large B-cell lymphoma who died within five hours of the initiation of a first course of chemotherapy including rituximab. Autopsy results suggested that the patient died of severe systemic inflammatory response syndrome. A literature review revealed that rituximab administered during the second course of chemotherapy (instead of during the first course) appears to reduce the incidence of infusion reactions (from 48% to 15%) without altering the frequency of complete remission outcomes.ConclusionsOur data indicate that the incidence of adverse reactions to rituximab can be markedly decreased if the tumor load is first reduced with an initial course of chemotherapy excluding rituximab. Future prospective studies of the timing of rituximab administration are warranted.

EBV-positive intravascular large B-cell lymphoma of the liver: a case report and literature review

“…Because of the absence of severe coagulopathy, ultrasonography-guided percutaneous liver biopsy was performed in our patient. Up to present, only 12 cases of IVLBCL diagnosed by liver biopsies have been described in the literature [10][11][12][13][14][15][16][17][18][19][20][21]. The clinical and immunohistochemical features of the reported cases and our case are summarized in The histopathological ndings presented in our case were consistent with those described in previous reports.…”

Severe cytokine release syndrome after the first dose of Brentuximab Vedotin in a patient with relapsed systemic anaplastic large cell lymphoma (sALCL): a case report and review of literature

“…While CRS has been observed repeatedly after application of rituximab and other antibodies especially in patients with high tumor burden , we found no similar case report for Brentuximab Vedotin in the published literature. This may be due to the fact that in contrast to rituximab which mediates destruction of malignant cells by complement activation and recruitment of macrophages , Brentuximab Vedotin is internalized into the target cells by endocytosis and only subsequently the anti‐microtubule agent MMAE is released .…”

EBV-positive intravascular large B-cell lymphoma of the liver: a case report and literature review

“…Because of the absence of severe coagulopathy, ultrasonography-guided percutaneous liver biopsy was performed in our patient. Up to present, only 11 cases of IVLBCL diagnosed by liver biopsies have been described in the literature [10][11][12][13][14][15][16][17][18][19][20]. The clinical and immunohistochemical features of the reported cases and our case are summarized in Table 2 and MUM-1, negative for CD10).…”