Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2012 Aug 31;16(4):231.
doi: 10.1186/cc11304.

Clinical review: Serious adverse events associated with the use of rituximab - a critical care perspective

Pashtoon M Kasi, Hussein A Tawbi, Chester V Oddis, Hrishikesh S Kulkarni
Review

Clinical review: Serious adverse events associated with the use of rituximab - a critical care perspective

Pashtoon M Kasi et al. Crit Care. .

Abstract

The advent of biologic agents has provided a more specific and targeted approach to the treatment of various hematological malignancies and other autoimmune disorders. Such biologic agents have been relatively well tolerated with fewer adverse events reported as compared with many other chemotherapeutic agents. Rituximab is a monoclonal antibody to the B-cell marker CD20 and is a common biologic agent widely used for the treatment of B-cell lymphoma, lymphoproliferative disorders, and inflammatory conditions that are refractory to conventional treatment, including rheumatoid arthritis and some vasculitides. However, through randomized controlled trials and post-marketing surveillance, an increasing number of serious adverse events are being associated with the use of rituximab, often leading to or complicating an intensive care unit admission. The purpose of this review is to focus on the severe complications that are associated with the use of rituximab and that require critical care. Management and prevention strategies for the most common complications along with some examples of its uses within the critical care setting are also discussed.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The proposed mechanisms of action for rituximab, a chimeric monoclonal antibody, against the CD 20 receptor. (1) Antibody-dependent cell-mediated cytotoxicity (ADCC). Effector cells include natural killer cells and phagocytic cells such as monocytes and macrophages that express Fc receptors. (2) Complement-dependent cytotoxicity (CDC). (3) Direct effects of binding (induction of apoptosis and sensitization to other chemotherapeutic agents). (4) Antibody-dependent phagocytosis (ADP).
Figure 2
Figure 2
Major serious adverse events as categorized by the system organ class devised by the National Cancer Institute.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. DiMasi JA, Grabowski HG. Economics of new oncology drug development. J Clin Oncol. 2007;25:209–216. doi: 10.1200/JCO.2006.09.0803. - DOI - PubMed
    1. Aggarwal S. Targeted cancer therapies. Nat Rev Drug Discov. 2010;9:427–428. doi: 10.1038/nrd3186. - DOI - PubMed
    1. Singh JA, Wells GA, Christensen R, Tanjong Ghogomu E, Maxwell L, Macdonald JK, Filippini G, Skoetz N, Francis D, Lopes LC, Guyatt GH, Schmitt J, La Mantia L, Weberschock T, Roos JF, Siebert H, Hershan S, Lunn MP, Tugwell P, Buchbinder R. Adverse effects of biologics: a network meta-analysis and Cochrane overview. Cochrane Database Syst Rev. 2011. p. CD008794. - PMC - PubMed
    1. Ghielmini M, Rufibach K, Salles G, Leoncini-Franscini L, Léger-Falandry C, Cogliatti S, Fey M, Martinelli G, Stahel R, Lohri A, Ketterer N, Wernli M, Cerny T, Schmitz SF. Single agent rituximab in patients with follicular or mantle cell lymphoma: clinical and biological factors that are predictive of response and event-free survival as well as the effect of rituximab on the immune system: a study of the Swiss Group for Clinical Cancer Research (SAKK) Ann Oncol. 2005;16:1675–1682. doi: 10.1093/annonc/mdi320. - DOI - PubMed
    1. Van Allen EM, Miyake T, Gunn N, Behler CM, Kohlwes J. Off-label use of rituximab in a multipayer insurance system. J Oncol Pract. 2011;7:76–79. doi: 10.1200/JOP.2010.000042. - DOI - PMC - PubMed

MeSH terms