Rituximab (Haematology)

How it works

It binds the CD20 antigen on B lymphocytes and depletes them through complement-dependent and antibody-dependent cell-mediated cytotoxicity and apoptosis.

Prescribing in practice

• Severe infusion-related reactions and cytokine release can occur, particularly with the first intravenous infusion and a high tumour burden, so give premedication and infuse with close monitoring at a controlled rate.
• Screen for hepatitis B before treatment because rituximab can reactivate the virus, sometimes fulminantly; reactivation of other infections including progressive multifocal leukoencephalopathy is also a risk.
• It causes prolonged B-cell depletion and hypogammaglobulinaemia, increasing infection risk, and live vaccines should be avoided.

Monitoring

Monitor closely for infusion reactions during administration, screen and watch for hepatitis B reactivation and infection, and check the full blood count and immunoglobulins.

Counselling the patient

• Report any rash, fever, breathlessness, chills or throat tightness during the infusion immediately.
• Tell the team promptly about any signs of infection, including after treatment finishes.
• Mention any new neurological symptoms such as confusion, weakness or vision changes.

Evidence & guidelines

Adding rituximab to chemotherapy improves outcomes in CD20-positive B-cell lymphoma and is recommended by NICE for relevant indications.