Risk factors and clinical consequences of rituximab infusion-related reactions

Rituximab is frequently used to treat B-cell lymphomas. The major adverse effect of rituximab is infusion-related reaction (IRR). The standard of care for IRR is not well established. We explored the incidence, risk factors, and impact on outcome of IRR in our institution. In total, 254 patients with B-cell lymphomas diagnosed from January 2016 to March 2018 were retrospectively reviewed. The median age was 61 (range 18-91). Diffuse large B-cell lymphoma (DLBCL) (71.3%) was the most common subtype of lymphomas. IRR occurred in 55 patients (21.7%). Incidence of IRR was significantly higher for follicular lymphoma (46.4%) than DLBCL (18.8%). Fifty patients (19.7%) experienced IRR at the first treatment cycle. Six of them had another IRR in subsequent treatment. Five patients had IRR ≥ grade 3. Two patients did not complete the treatment courses due to IRR. Rituximab-associated IRR is manageable by a slower infusion rate and administration of steroids and antihistamines. Patients experiencing IRR should not be excluded from subsequent rituximab treatment. Incidence of IRR is higher in follicular lymphoma than DLBCL. IRR is not predicted by any risk factors and do not affect the clinical outcome of patients with B-cell lymphomas.