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A Retrospective Study on Infusion-Related Reactions to Rituximab in a Heterogeneous Pediatric Population

Clément Legeay1, Henrique Bittencourt1, Elie Haddad1

  • 1Department of Pharmacy (CL, RT), CHU Ste Justine, University of Montreal, Montréal, Quebec, Canada; Department of Oncology-Haematology (HB), CHU Ste Justine, University of Montreal, Montréal, Quebec, Canada; Department of Pediatrics, Department of Microbiology, Infectiology and Immunology (EH), University of Montreal, Montreal, Quebec, Canada; Department of Pharmacy (JSR), CHU d'Angers, University of Angers, Angers, France; Department of Medical Information (VTS), CHU d'Angers, University of Angers, Angers, France.

The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
|October 19, 2017
PubMed

Insights

Infusion-related reactions to rituximab were common with the first dose in pediatric patients but rare thereafter. Elevated absolute lymphocyte count was identified as a key risk factor for these reactions.

Area of Science:

  • Pediatric Hematology/Oncology
  • Immunology
  • Pharmacology

Background:

  • Rituximab is an important therapeutic agent used for various conditions in pediatric patients.
  • Understanding infusion-related reactions (IRRs) is crucial for safe rituximab administration.
  • Pediatric populations may exhibit unique responses to immunotherapy.

Purpose of the Study:

  • To evaluate the incidence, severity, and risk factors of infusion-related reactions to rituximab.
  • To analyze outcomes of these reactions in a diverse group of pediatric patients.
  • To identify predictors for rituximab-induced infusion-related reactions.

Main Methods:

  • Retrospective analysis of pediatric patients receiving rituximab between July 2010 and July 2012.
  • Data collection included demographics, infusion details, reaction grading, and biological markers (absolute lymphocyte count, lactate dehydrogenase).
  • Multivariate analysis was employed to identify significant risk factors for infusion-related reactions.

Main Results:

  • Sixty-seven pediatric patients received 282 rituximab infusions for 17 different indications.
  • Infusion-related reactions occurred in 30 patients (44.8%), predominantly grade 1 or 2.
  • Reactions were significantly more frequent during the first infusion (39.2%) compared to subsequent infusions (2.7%).
  • Elevated absolute lymphocyte count was the sole identified risk factor for infusion-related reactions (OR = 1.03; 95% CI: 1.01-1.06; p = 0.014).

Conclusions:

  • Rituximab infusion-related reactions are frequent during the initial dose in pediatric patients but uncommon in later infusions.
  • These reactions are generally mild and effectively managed with pharmacological interventions.
  • Pre-infusion absolute lymphocyte count is a significant predictor of infusion-related reactions in pediatric rituximab recipients.
Abstract

Keywords:
hematologyimmunologyinfusion reactionspediatricrituximab

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