Praxis Medical Insights

Incidence and Symptoms

Rituximab infusion-related reactions occur in up to 77% of patients during the first infusion, with severe reactions in approximately 10% of cases, according to the American College of Oncology 1, 2
Symptoms of infusion-related reactions include fever, chills, rash, dyspnea, hypotension, nausea, rhinitis, urticaria, pruritus, asthenia, angioedema, and bronchospasm 1, 2

Grade 1-2 reactions are characterized by symptoms such as fever, chills, pruritus, flushing, mild rash, mild dyspnea, mild hypotension, and nausea, and typically respond well to symptomatic treatment and temporary infusion rate adjustment, as recommended by the American College of Oncology 1, 2
Grade 3 reactions are characterized by significant bronchospasm, severe hypotension, severe dyspnea, severe urticaria, and angioedema, and require immediate intervention and may necessitate discontinuation of therapy, according to the American College of Oncology 1, 2
Grade 4 reactions are life-threatening and include symptoms such as anaphylaxis, cardiac/respiratory arrest, and severe bronchospasm requiring ventilation support, and require immediate discontinuation of rituximab and emergency intervention, as recommended by the American College of Oncology 2

A slow initial rate of infusion is recommended for all patients, and premedication with antipyretic and antihistamine is recommended, according to the American College of Oncology 2
For Grade 1-2 reactions, stop or slow the infusion rate, provide symptomatic treatment, and restart infusion at 50% of the previous rate after resolution of symptoms, as recommended by the American College of Oncology 1, 2
For Grade 3 reactions, immediately stop the infusion, administer aggressive symptomatic treatment, and consider resuming treatment at half the previous rate after complete resolution of symptoms, according to the American College of Oncology 1, 2
For Grade 4 reactions, permanently discontinue rituximab, provide emergency resuscitative measures, and consider ICU admission for monitoring, as recommended by the American College of Oncology 1, 2

Following any infusion reaction, patients should be observed for a minimum of 1-2 hours after the infusion is complete, and consider more intensive premedication, a slower initial infusion rate, and more frequent monitoring during subsequent infusions, according to the American College of Oncology 1, 2
Delayed reactions can occur up to 24 hours after infusion, so patient education about potential delayed symptoms is essential, as recommended by the American College of Oncology 1