Addition of rituximab to cyclophosphamide, doxorubicin, vincristine, and prednisolone therapy has a high risk of developing interstitial pneumonia in patients with non-Hodgkin lymphoma

• Published in: Leukemia & lymphoma 2009-11, Vol.50 (11), p.1818-1823
• Main Authors: Katsuya, Hiroo, Suzumiya, Junji, Sasaki, Hidenori, Ishitsuka, Kenji, Shibata, Takao, Takamatsu, Yasushi, Tamura, Kazuo
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; DNA, Fungal - genetics; Doxorubicin - administration & dosage; Doxorubicin - adverse effects; Female; Granulocyte Colony-Stimulating Factor - administration & dosage; Granulocyte Colony-Stimulating Factor - adverse effects; Humans; interstitial pneumonitis; Lung Diseases, Interstitial - chemically induced; Lung Diseases, Interstitial - diagnosis; Lung Diseases, Interstitial - microbiology; Lymphocyte Count; Lymphoma, Non-Hodgkin - drug therapy; Male; Middle Aged; Pneumocystis carinii - genetics; Pneumocystis carinii - isolation & purification; Pneumocystis jirovecii pneumonia; Polymerase Chain Reaction; Prednisolone - administration & dosage; Prednisolone - adverse effects; Retrospective Studies; Risk Assessment; Rituximab; Vincristine - administration & dosage; Vincristine - adverse effects
• ISSN: 1042-8194; 1029-2403
• DOI: 10.3109/10428190903258780

There are a few reports suggesting that rituximab (RTX) might be a risk for interstitial pneumonitis (IP). We also experienced such patients in the era of RTX. Here, we reviewed all the patients with non-Hodgkin lymphoma who were treated with RTX-CHOP-like regimen (R-CHOP) to determine the risk of developing IP. One of 59 (1.7%) patients who received CHOP alone and 8 of 129 (6.2%) patients who were treated with R-CHOP experienced IP (p = 0.28). Furthermore, three of eight patients who have had IP during R-CHOP were confirmed having Pneumocystis jirovecii pneumonia (PCP). PCP occurred during the fourth, sixth, and seventh cycle of chemotherapy, respectively. Among the patients treated by R-CHOP, 3 of 32 (9%) patients whose lymphocyte counts were 1000/μL did not (p = 0.03). In four of eight patients, IP occurred during the administration of granulocyte-colony stimulating factor. RTX seems to have a certain risk to induce IP including PCP. Patients with lymphoma who were treated by R-CHOP regimen, might be considered as PCP prophylactic, especially if the number of lymphocytes is low at the beginning of chemotherapy.