gms | German Medical Science

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010)

Deutsche Gesellschaft für Infektiologie,
Deutsche AIDS-Gesellschaft,
Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit,
Paul-Ehrlich-Gesellschaft für Chemotherapie

23.06. - 26.06.2010, Köln

Opportunistic infections following rituximab-containing therapy for Non-Hodgkin's lymphoma and immunthrombocytopenic purpura

Opportunistische Infektionen nach Rituximab-haltiger Chemo-Immuntherapie bei Non-Hodgkin-Lymphomen und immunthrombozytopenischer Purpura

Meeting Abstract

  • M. Hentrich - Klinikum Harlaching, Klinik für Hämatologie, Onkologie und Palliativmedizin, München, Germany
  • A. Gerl - Onkologische Schwerpunktpraxis, München, Germany
  • L. Lutz - Klinikum Harlaching, Klinik für Hämatologie, Onkologie und Palliativmedizin, München, Germany
  • M. Karthaus - Klinikum Harlaching, Klinik für Hämatologie, Onkologie und Palliativmedizin, München, Germany
  • X. Schiel - Klinikum Harlaching, Klinik für Hämatologie, Onkologie und Palliativmedizin, München, Germany

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010). Köln, 23.-26.06.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP48

DOI: 10.3205/10kit104, URN: urn:nbn:de:0183-10kit1046

Veröffentlicht: 2. Juni 2010

© 2010 Hentrich et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objectives: Rituximab (R) is established as standard therapy for a variety of B-cell Non-Hodgkin lymphoma (NHL). In most instances adverse events are mild to moderate. However, in rare cases R may be associated with opportunistic infections (OI).

Methods: The records of consecutive pts treated at 2 institutions from 01/06 to 12/08 with R-containing chemotherapy or R-maintenance therapy (R-M) for NHL or immunthrombocytopenic purpura (ITP) were analyzed for OI.

Results: 113 pts (68 males, 45 females) with a median age of 67 yrs (range 26–87) were included in the cohort study. A total of 760 cycles of R were evaluable for OI. Pts received a median of 6.9 cycles (range 1–18) of R for indolent lymphoma (n=41), aggressive lymphoma (n=54), mantle cell lymphoma (n=13) or ITP (n=5). The R-CHOP regimen was most frequently administered (67% of pts). Three of 113 pts (3%) experienced OI. Pt 1, a 75-yrs-old male, developed pneumocystis jirovecii pneumonia (PCP) after 5x R-CHOP-14 for diffuse large B-cell lymphoma (DLBCL). Atypical pneumonia occurred in pt. 2, a 76-yrs-old female, after 6x R-CHOP-21 for Richter`s syndrome. Pat. 3 was a 74-yrs-old man with recurrent BALT lymphoma who developed generalized herpes zoster following 6x R-bendamustine (RB) plus 1x R-M. In each case OI resolved under appropriate antimicrobial/virustatic therapy. R-M was restarted in pt 3 while R was terminated in pt 1 and pt 2. All pts are alive and well after a mean follow-up of 24 months. Furthermore, 2 additional pts were transferred to our department for therapy of enterovirus-induced encephalitis after 6x R-CHOP-21 + 2x R-M for follicular lymphoma (n=1) and cerebral toxoplasmosis in a pt heavily pretreated with R-containing therapy for relapsed mantle cell lymphoma (n=1).

Conclusions: OI are rare but potentially fatal complications. Rapid diagnostic proceedings and initiation of therapy are crucial. In selected cases careful reexposure of R may be feasible.