Rituximab use for lymphoplasmacytic lymphoma during continuous renal replacement therapy

Area of Science:

• Pharmacology and Nephrology
• Oncology and Critical Care Medicine

Background:

• The safety and efficacy of rituximab in patients with renal impairment are not well-established.
• Limited data exist on rituximab's pharmacokinetics during hemodialysis and no data are available for continuous renal replacement therapy (CRRT).
• This study addresses the knowledge gap regarding rituximab use in critically ill patients with acute kidney injury requiring CRRT.

Observation:

• A 59-year-old female with lymphoplasmacytic lymphoma presented with paraneoplastic tetraparesis, alveolar hemorrhage, respiratory failure, and acute kidney injury necessitating CRRT.
• The patient received rituximab and cyclophosphamide therapy.
• Serum and dialysate rituximab levels were measured; rituximab was undetectable in the dialysate.

Findings:

• Rituximab was not found in the dialysate of a patient undergoing CRRT, suggesting that CRRT may not significantly clear rituximab.
• This observation provides preliminary data on rituximab pharmacokinetics in the context of CRRT.

Implications:

• These findings suggest that rituximab dosing may not require adjustment in patients receiving CRRT, although further studies are needed.
• This case contributes to understanding rituximab's behavior in patients with severe renal impairment and highlights the need for more research on its use in this population.