Article
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
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Published: | June 2, 2010 |
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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.