Rituximab (intravenous): Drug information
Copyright 1978-2018 Lexicomp, Inc. All rights reserved.
(For additional information see "Rituximab (intravenous): Patient drug information" and see "Rituximab (intravenous): Pediatric drug information")

For abbreviations and symbols that may be used in Lexicomp (show table)
ALERT: US Boxed Warning
Infusion reactions:

Rituximab administration can result in serious, including fatal, infusion reactions. Deaths within 24 hours of rituximab infusion have been reported. Approximately 80% of fatal infusion reactions occurred in association with the first infusion.

Monitor patients closely. Discontinue rituximab infusion for severe reactions and administer medical treatment for grade 3 or 4 infusion reactions.

Mucocutaneous reactions:

Severe, including fatal, mucocutaneous reactions can occur in patients receiving rituximab.

Hepatitis B virus reactivation:

Hepatitis B virus (HBV) reactivation can occur in patients treated with rituximab, in some cases resulting in fulminant hepatitis, hepatic failure, and death. Screen all patients for HBV infection before treatment initiation, and monitor patients during and after treatment with rituximab. Discontinue rituximab and concomitant medications in the event of HBV reactivation.

Progressive multifocal leukoencephalopathy:

Progressive multifocal leukoencephalopathy (PML) and death can occur in patients receiving rituximab.

Brand Names: US
  • Rituxan
Brand Names: Canada
  • Rituxan
Pharmacologic Category
  • Antineoplastic Agent, Anti-CD20;
  • Antineoplastic Agent, Monoclonal Antibody;
  • Antirheumatic, Miscellaneous;
  • Immunosuppressant Agent;
  • Monoclonal Antibody
Dosing: Adult

Note: Pretreatment with acetaminophen and an antihistamine is recommended for all indications. For oncology uses, antihyperuricemic therapy and aggressive hydration are recommended for patients at risk for tumor lysis syndrome (high tumor burden or lymphocytes >25,000/mm3). In patients with chronic lymphocytic leukemia (CLL), Pneumocystis jirovecii pneumonia (PCP) and antiherpetic viral prophylaxis is recommended during treatment (and for up to 12 months following treatment). In patients with granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), PCP prophylaxis is recommended during and for 6 months after rituximab treatment. For patients with rheumatoid arthritis (RA), premedication with methylprednisolone 100 mg IV (or equivalent) is recommended 30 minutes prior to each dose.

Chronic lymphocytic leukemia: IV: 375 mg/m2 on the day prior to fludarabine/cyclophosphamide in cycle 1, then 500 mg/m2 on day 1 (every 28 days) of cycles 2 to 6 (in combination with fludarabine and cyclophosphamide)

Chronic lymphocytic leukemia (off-label combinations): IV: 375 mg/m2 on the day prior to bendamustine in cycle 1, then 500 mg/m2 on day 1 (every 28 days) of cycles 2 to 6 (in combination with bendamustine) (Eichorst 2016) or 375 mg/m2 on day 1, followed by 500 mg/m2 every 14 days for 4 doses and then 500 mg/m2 every 28 days for 3 doses (in combination with idelalisib) (Furman 2014)

Granulomatosis with polyangiitis (GPA; Wegener granulomatosis): IV: 375 mg/m2 once weekly for 4 doses (in combination with methylprednisolone IV for 1 to 3 days followed by daily prednisone)

Microscopic polyangiitis (MPA): IV: 375 mg/m2 once weekly for 4 doses (in combination with methylprednisolone IV for 1 to 3 days followed by daily prednisone)

Non-Hodgkin lymphoma (NHL; relapsed/refractory, low-grade or follicular CD20-positive, B-cell): IV: 375 mg/m2 once weekly for 4 or 8 doses (as a single agent)

Re-treatment following disease progression: 375 mg/m2 once weekly for 4 doses

For maintenance therapy (as a single agent, in patients with response to induction therapy), the following recommendations have been made: IV: 375 mg/m2 every 3 months until disease progression or maximum duration of 2 years (Rituxan IV Canadian product labeling 2016)

NHL (diffuse large B-cell): IV: 375 mg/m2 given on day 1 of each chemotherapy cycle for up to 8 doses (in combination with CHOP chemotherapy [or other anthracycline-based regimen])

NHL (follicular, CD20-positive, B-cell, previously untreated): IV: 375 mg/m2 given on day 1 of each chemotherapy cycle for up to 8 doses (in combination with first-line chemotherapy)

Maintenance therapy (as a single agent, in patients with partial or complete response to rituximab plus chemotherapy; begin 8 weeks after completion of rituximab in combination with chemotherapy): IV: 375 mg/m2 once every 8 weeks for 12 doses

NHL (nonprogressing, low-grade, CD20-positive, B-cell, after 6 to 8 cycles of first line CVP are completed): IV: 375 mg/m2 once weekly for 4 doses every 6 months for a maximum of 16 doses (as a single agent)

NHL: Combination therapy with ibritumomab: IV: 250 mg/m2 IV day 1; repeat in 7 to 9 days with ibritumomab (also see Ibritumomab monograph)

Rheumatoid arthritis: IV: 1,000 mg on days 1 and 15 (in combination with methotrexate); subsequent courses may be administered every 24 weeks (based on clinical evaluation), if necessary may be repeated no sooner than every 16 weeks

Antibody-mediated rejection in cardiac transplantation, treatment (off-label use): IV: 375 mg/m2 once weekly for 1 to 4 doses (AHA [Colvin 2015]; ISHLT [Costanzo 2010]) or 1,000 mg on days 7 and 21 or on days 7 and 22 (AHA [Colvin 2015])

Autoimmune hemolytic anemia, refractory (off-label use): IV: 375 mg/m2 once weekly for 4 doses (may continue systemic corticosteroids); a second course may be administered for relapse (Gobert 2011; Reynaud 2015; Roumier 2014)

Burkitt lymphoma (off-label use): IV: 375 mg/m2 on day 1 and 11 of cycles 1 and 3 and days 2 and 8 of cycles 2 and 4 (Thomas 2006) or 375 mg/m2 at the start of each chemotherapy cycle, followed by 2 additional doses 3 and 6 weeks after the completion of chemotherapy (Hoelzer 2014) or 50 mg/m2 on day 8 and 375 mg/m2 on days 10 and 12 of cycle 2 followed by 375 mg/m2 on day 8 of cycles 3 to 7 (Rizzieri 2014).

CNS lymphoma (off-label use): IV:

Newly diagnosed: 375 mg/m2 on day 3 every 14 days (in combination with high-dose methotrexate) until disease progression or unacceptable toxicity, or for 2 doses beyond a complete response followed by monthly treatments for up to a total of 1 year (Holdhoff 2014) or 500 mg/m2 on day 1 of each cycle for 5 to 7 induction cycles (in combination with high-dose methotrexate, vincristine, and procarbazine, followed by whole-brain radiotherapy and cytarabine consolidation) (Shah 2007)

Refractory disease: 375 mg/m2 on day 1 every 28 days (in combination with temozolomide) for 4 cycles, then followed by temozolomide monotherapy (Wong 2004)

Graft-versus-host disease (GVHD), chronic, refractory (off-label use): IV: 375 mg/m2 once weekly for 4 doses; a second course of 4 weekly doses may be administered 8 weeks after initial therapy for lack of or incomplete response (Cutler 2006) or 375 mg/m2 once weekly for 4 to 8 doses (Wolff 2011)

Hodgkin lymphoma, nodular lymphocyte-predominate, advanced (off-label use): IV: 375 mg/m2 once weekly for 4 weeks (Ekstrand 2003; Schulz 2008) or 375 mg/m2 once weekly for 4 weeks followed by maintenance dosing of 375 mg/m2 once weekly for 4 weeks every 6 months for 2 years (Advani 2014). May be administered as a single agent or in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone [R-CHOP], or for relapsed disease, in combination with ifosfamide, carboplatin and etoposide [RICE]) (Advani 2013).

Idiopathic membranous nephropathy, resistant (off-label use): IV: 375 mg/m2 once weekly for 4 doses; repeat cycle at 6 months (Fervenza 2010) or 1,000 mg (flat dose) on days 1 and 15; may repeat cycle at 6 months (Fervenza 2008) or 375 mg/m2 once weekly for 2 doses (Dahan 2016) or 375 mg/m2 once weekly for 4 doses (Ruggenenti 2012; Ruggenenti 2015) or 375 mg/m2 as a single dose and repeated at least 1 week later only if circulating B-cells >5/mm3 were detected (Ruggenenti 2012; Ruggenenti 2015)

Immune thrombocytopenia, refractory (off-label use): IV: 375 mg/m2 once weekly for 4 doses (Arnold 2007; Godeau 2008; Provan 2010) or some patients may have a response with a dose of 100 mg (flat dose) once weekly for 4 weeks (Zaja 2010).

Lupus nephritis, refractory (off-label use): IV: 375 mg/m2 once weekly for 4 doses (Diaz-Largares 2012; Melander 2009) or 1,000 mg (flat dose) on days 0 and 15 (Diaz-Largares 2012) or 500 to 1,000 mg (flat dose) on days 1 and 15 (Vigna-Perez 2006)

Mucosa-associated lymphoid tissue lymphoma (gastric), advanced (off-label use): IV: 375 mg/m2 once weekly for 4 doses (Martinelli 2005)

Myasthenia gravis, severe, refractory (off-label use): IV: 375 mg/m2 once weekly for 4 weeks, then once a month for 2 months; repeat if symptomatic (Diaz-Manera 2012) or 375 mg/m2 once weekly for 4 weeks; may repeat if clinically indicated (Tandan 2017). Additional data may be necessary to further define the role of rituximab in the management of refractory myasthenia gravis.

Neuromyelitis optica, relapse prevention (off-label use): IV: 1,000 mg once every 2 weeks for 2 doses, repeat every 6 months or when monthly CD19 cells counts are >0.1% of total lymphocytes (Damato 2016; Mealy 2014; Trebst 2014) or 375 mg/m2 once weekly for 4 weeks, repeat every 6 months (Damato 2016; Trebst 2014). Additional data may be necessary to further define the role of rituximab in the prevention of neuromyelitis optica relapse.

Pemphigus vulgaris, newly diagnosed (off-label use): IV: 1,000 mg once every 2 weeks for 2 doses (in combination with prednisone), followed by 500 mg at months 12 and 18 (Joly 2017). Additional data may be necessary to further define the role of rituximab as initial therapy for newly diagnosed pemphigus vulgaris.

Pemphigus vulgaris, refractory (off-label use): IV: 375 mg/m2 once weekly for 4 doses (some patients also continued immunosuppressant therapy); may repeat a second time (based on response) if needed (Cholera 2016; El Tal 2006; Kasperkiewicz 2008) or 375 mg/m2 once weekly of weeks 1, 2, and 3 of a 4-week cycle, repeat for 1 additional cycle, then 1 dose per month for 4 months (total of 10 doses in 6 months), in combination with IV immune globulin (Ahmed 2006) or 1,000 mg once every 2 weeks for 2 doses (some patients also continued immunosuppressant therapy) (Cholera 2016; Kasperkiewicz 2008)

Posttransplant lymphoproliferative disorder (off-label use): IV: 375 mg/m2 once weekly for 4 doses (Choquet 2006) or 375 mg/m2 once weekly for 4 doses, followed 4 weeks later with 4 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy (Trappe 2012)

Splenic marginal zone lymphoma (off-label use): IV: 375 mg/m2 once weekly for 6 weeks followed by 375 mg/m2 once every 2 months for 1 to 2 years (Kalpadakis 2013) or 375 mg/m2 once weekly for 4 weeks as monotherapy or 375 mg/m2 on day 1 of each chemotherapy cycle for up to 6 cycles; 1 to 2 additional cycles of rituximab monotherapy may be administered for consolidation or to improve response (Else 2012). Additional data may be necessary to further define the role of rituximab in this condition.

Thrombotic thrombocytopenic purpura (acquired) (off-label use): IV: 375 mg/m2 once weekly for 4 doses (in combination with plasma exchange); up to 4 additional doses may be administered for ADAMTS13 levels remaining below normal or for persistently detectable anti-ADAMTS13 IgG antibodies (Scully 2007; Scully 2011). Rituximab should be timed to be administered immediately following plasma exchange; allow 24 hours after rituximab before the next plasma exchange (McDonald 2010; Sayani 2015).

Waldenström macroglobulinemia (off-label use): IV:

Single-agent rituximab: 375 mg/m2 once weekly for 4 weeks as a single agent; may repeat cycle one time after 12 weeks (Dimopoulos 2002).

In combination with cyclophosphamide and dexamethasone: 375 mg/m2 on day 1 every 21 days for 6 cycles (Dimopoulos 2007).

In combination with bortezomib: 375 mg/m2 on days 1, 8, 15, and 22 every 28 days during cycles 1 and 4; treatment is continued for 6 cycles, with a total of 8 rituximab doses (Ghobrial 2010).

In combination with bortezomib and dexamethasone: 375 mg/m2 on days 1, 8, 15, and 22 every 35 days during cycles 2 and 5; treatment is administered for 6 cycles, with a total of 8 rituximab doses (Dimopoulos 2013) or 375 mg/m2 on day 11 every 21 days for 4 cycles (induction); after a 12-week break, 4 additional maintenance cycles (spaced 12 weeks apart) were administered (Treon 2009).

In combination with bendamustine: 375 mg/m2 on day 1 every 28 days for 4 cycles; single rituximab doses were also administered 1 week prior to the first cycle and 4 weeks after the last cycles (for a total of 6 rituximab doses) (Rummel 2005).

In combination with carfilzomib and dexamethasone: 375 mg/m2 on days 2 and 9 every 21 days for 6 induction cycles, followed by 375 mg/m2 on day 2 every 8 weeks for 8 maintenance cycles (Treon 2014).

Dosing: Pediatric

(For additional information see "Rituximab (intravenous): Pediatric drug information")

Note: Pretreatment with acetaminophen and an antihistamine is recommended.

Autoimmune hemolytic anemia, refractory (off-label use): IV: 375 mg/m2 once weekly for 2 to 4 doses (may continue systemic corticosteroids); a second course may be administered for relapse (Rao 2008; Zecca 2003).

Immune thrombocytopenia, refractory (off-label use): IV: 375 mg/m2 once weekly for 4 doses (Parodi 2009; Provan 2010; Wang 2005)

Nephrotic syndrome, severe, refractory (off-label use): IV: 375 mg/m2 once weekly for 2 to 4 doses or 375 mg/m2 (maximum dose: 500 mg) as a single dose (Dello Strologo 2009; Fujinaga 2010; Guigonis 2008; Prytula 2010). Additional data may be necessary to further define the role of rituximab in this condition.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Dosing: Adjustment for Toxicity

Dosage adjustments for rituximab are not recommended; however, adjustments for concomitant chemotherapy may be necessary.

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous [preservative free]:

Rituxan: 10 mg/mL (10 mL, 50 mL) [contains polysorbate 80]

Generic Equivalent Available (US)

No

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and at http://www.fda.gov/downloads/Drugs/DrugSafety/UCM169892.pdf, must be dispensed with this medication.

Administration

Note: Some pediatric protocols utilize an alternate rituximab administration rate. Refer to specific protocol for administration rate guidelines.

IV: For IV administration only. Do not administer IV push or bolus. Do not administer IV rituximab subcutaneously. If an infusion reaction occurs, slow or stop the infusion. If the reaction abates, restart infusion at 50% of the previous rate. Discontinue infusion in the event of serious or life-threatening cardiac arrhythmias.

Initial infusion: Start infusion at a rate of 50 mg/hour; if there is no infusion reaction, increase the rate by 50 mg/hour increments every 30 minutes, to a maximum rate of 400 mg/hour.

Subsequent infusions:

Standard infusion rate: If patient tolerated initial infusion, start at 100 mg/hour; if there is no infusion reaction, increase the rate by 100 mg/hour increments every 30 minutes, to a maximum rate of 400 mg/hour.

Accelerated infusion rate (90 minutes): For patients with previously untreated follicular NHL and diffuse large B-cell NHL who are receiving a corticosteroid as part of their combination chemotherapy regimen, have a circulating lymphocyte count <5,000/mm3, or have no significant cardiovascular disease. After tolerance has been established (no grade 3 or 4 infusion-related event) at the recommended infusion rate in cycle 1, a rapid infusion rate may be used beginning with cycle 2. The daily corticosteroid, acetaminophen, and diphenhydramine are administered prior to treatment, then the rituximab dose is administered over 90 minutes, with 20% of the dose administered over the first 30 minutes and the remaining 80% is given over 60 minutes (Sehn 2007). If the 90-minute infusion in cycle 2 is tolerated, the same rate may be used for the remainder of the treatment regimen (through cycles 6 or 8).

Use

Chronic lymphocytic leukemia: Treatment of previously untreated or previously treated CD20-positive chronic lymphocytic leukemia (CLL) (in combination with fludarabine and cyclophosphamide).

Granulomatosis with polyangiitis: Treatment of granulomatosis with polyangiitis (GPA; Wegener granulomatosis) (in combination with glucocorticoids).

Microscopic polyangiitis: Treatment of microscopic polyangiitis (MPA) (in combination with glucocorticoids).

Non-Hodgkin lymphomas: Treatment of CD20-positive non-Hodgkin lymphomas (NHL):

Relapsed or refractory, low-grade or follicular B-cell NHL (as a single agent)

Follicular B-cell NHL, previously untreated (in combination with first-line chemotherapy, and as single-agent maintenance therapy if complete or partial response to first-line rituximab with chemotherapy)

Nonprogressing (including stable disease), low-grade B-cell NHL (as a single agent after first-line CVP treatment)

Diffuse large B-cell NHL, previously untreated (in combination with CHOP chemotherapy [or other anthracycline-based regimen])

Rheumatoid arthritis: Treatment of moderately to severely active rheumatoid arthritis (in combination with methotrexate) in adult patients with inadequate response to one or more TNF antagonist therapies.

Limitations of use: Rituximab is not recommended for use in patients with severe, active infections.

Use: Off-Label

Antibody-mediated rejection in cardiac transplantation (treatment); Autoimmune hemolytic anemia (refractory) (adults); Autoimmune hemolytic anemia (refractory) (children/adolescents); Burkitt lymphoma; CNS lymphoma; Graft-versus-host disease (chronic, steroid-refractory); Hodgkin lymphoma (nodular lymphocyte-predominant), advanced; Idiopathic membranous nephropathy (resistant); Immune thrombocytopenia (refractory) (adults); Immune thrombocytopenia (refractory) (children/adolescents); Lupus nephritis (refractory) (adults); Mucosa-associated lymphoid tissue lymphoma (gastric) (advanced); Myasthenia gravis (refractory); Nephrotic syndrome, severe, refractory (pediatrics); Neuromyelitis optica (relapse prevention); Pemphigus vulgaris (newly diagnosed); Pemphigus vulgaris (refractory); Post-transplant lymphoproliferative disorder; Splenic marginal zone lymphoma; Thrombotic thrombocytopenic purpura (acquired); Waldenström macroglobulinemia

Medication Safety Issues
Sound-alike/look-alike issues:

Rituxan may be confused with Remicade, Rituxan Hycela

RiTUXimab may be confused with brentuximab, bevacizumab, inFLIXimab, obinutuzumab, ofatumumab, ramucirumab, rituximab and hyaluronidase, ruxolitinib

High alert medication:

This medication is in a class the Institute for Safe Medication Practices (ISMP) includes among its list of drug classes that have a heightened risk of causing significant patient harm when used in error.

Administration issues:

Rituximab is for intravenous (IV) administration only. Do not substitute rituximab and hyaluronidase (SubQ) for rituximab (IV). Use caution during product selection, preparation, and administration.

The rituximab dose for rheumatoid arthritis is a flat dose (1000 mg) and is not based on body surface area (BSA).

Adverse Reactions

Patients treated with rituximab for rheumatoid arthritis (RA) may experience fewer adverse reactions.

>10%:

Cardiovascular: Peripheral edema (8% to 16%), hypertension (6% to 12%)

Central nervous system: Fatigue (13% to 39%), chills (3% to 33%), neuropathy (≤30%), headache (17% to 19%), insomnia (≤14%), pain (12%)

Dermatologic: Skin rash (10% to 17%), pruritus (5% to 17%), night sweats (15%)

Endocrine & metabolic: Weight gain (11%)

Gastrointestinal: Nausea (8% to 23%), diarrhea (10% to 17%), abdominal pain (2% to 14%)

Hematologic & oncologic: Lymphocytopenia (48%; grades 3/4: 40%; median duration: 14 days), anemia (8% to 35%; grades 3/4: 3%), leukopenia (NHL: 14%, grades 3/4: 4%; CLL: grades 3/4: 23%; GPA/MPA: 10%), neutropenia (NHL: 14%, grades 3/4: 4% to 6%, median duration: 13 days; CLL: grades 3/4: 30% to 49%; late-onset: <1%, occurs >40 days after last dose), thrombocytopenia (12%; grades 3/4: 2% to 11%), cytopenia (may be prolonged), febrile neutropenia (CLL)

Hepatic: Increased serum ALT (≤13%)

Hypersensitivity: Angioedema (11%)

Immunologic: Antibody development (human antichimeric antibody [HACA] positive: 1% to 23%)

Infection: Infection (19% to 62%), bacterial infection (19%)

Neuromuscular & skeletal: Weakness (2% to 26%), muscle spasm (≤17%), arthralgia (6% to 13%)

Respiratory: Cough (13%), rhinitis (3% to 12%), epistaxis (≤11%)

Miscellaneous: Infusion related reaction (lymphoma: first dose: 77%, decreases with subsequent infusions and may include rigors; CLL: 59%, grades 3/4: 7% to 9%; RA: first infusion: 32%; GPA/MPA: 12%), fever (5% to 53%)

1% to 10%:

Cardiovascular: Hypotension (10%), flushing (5%)

Central nervous system: Dizziness (10%), anxiety (2% to 5%), migraine (RA: 2%), paresthesia (2%)

Dermatologic: Urticaria (2% to 8%)

Endocrine & metabolic: Hyperglycemia (9%), increased lactate dehydrogenase (7%)

Gastrointestinal: Vomiting (10%), dyspepsia (RA: 3%)

Infection: Viral infection (10%), fungal infection (1%)

Neuromuscular & skeletal: Back pain (10%), myalgia (10%)

Respiratory: Dyspnea (≤10%), throat irritation (2% to 9%), bronchospasm (8%), upper respiratory tract infection (RA: 7%), sinusitis (6%)

<1%, postmarketing and/or case reports: Acute mucocutaneous toxicity, acute renal failure, acute respiratory distress, anaphylactoid reaction, anaphylaxis, angina pectoris, aplastic anemia, arthritis (polyarticular), bone marrow depression, bronchiolitis obliterans, cardiac arrhythmia, cardiac failure, cardiogenic shock, encephalitis, fulminant hepatitis, gastrointestinal perforation, hemolytic anemia, hepatic failure, hepatitis, hypogammaglobulinemia (prolonged), hypoxia, increased serum immunoglobulins (hyperviscosity syndrome in Waldenstrom’s macroglobulinemia), interstitial pneumonitis, intestinal obstruction, intestinal perforation, Kaposi’s sarcoma (progression), laryngeal edema, lichenoid dermatitis, lupus-like syndrome, mucositis, myelitis, myocardial infarction, nephrotoxicity, optic neuritis, pancytopenia (prolonged), pemphigus (paraneoplastic; uncommon), pleurisy, pneumonia, pneumonitis, polymyositis, progressive multifocal leukoencephalopathy, pure red cell aplasia, reactivated tuberculosis, reactivation of HBV, reversible posterior leukoencephalopathy syndrome, serum sickness, Stevens-Johnson syndrome, supraventricular cardiac arrhythmia, toxic epidermal necrolysis, tumor lysis syndrome, uveitis, vasculitic rash, vasculitis (systemic), ventricular fibrillation, ventricular tachycardia, vesiculobullous dermatitis, viral infection (reactivation; includes JC virus infection, cytomegalovirus, herpes simplex virus, parvovirus B19, varicella-zoster virus, West Nile disease, and hepatitis C), wheezing

Contraindications

There are no contraindications listed in the manufacturer's US labeling.

Canadian labeling: Known type 1 hypersensitivity or anaphylactic reaction to murine proteins, Chinese Hamster Ovary (CHO) cell proteins, or any component of the formulation; patients who have or have had progressive multifocal leukoencephalopathy (PML); patients with severe, active infections

Warnings/Precautions

Concerns related to adverse effects:

• Bowel obstruction/perforation: Abdominal pain, bowel obstruction, and perforation have been reported (rarely fatal), with an average onset of symptoms of ~6 days (range: 1 to 77 days); evaluate abdominal pain or repeated vomiting.

• Cardiovascular effects: Discontinue infusion for serious or life-threatening cardiac arrhythmias. Perform cardiac monitoring during and after the infusion in patients who develop clinically significant arrhythmias or who have a history of arrhythmia or angina.

• Cytopenias: Rituximab is associated with lymphopenia, leukopenia, neutropenia, thrombocytopenia, and anemia; the duration of cytopenias may be prolonged and may extend months beyond treatment. Monitor blood counts.

• Hepatitis B virus reactivation: [US Boxed Warning]: Hepatitis B virus (HBV) reactivation may occur with rituximab and in some cases may result in fulminant hepatitis, hepatic failure, and death. Screen all patients for HBV infection prior to treatment initiation, and monitor patients during and after treatment with rituximab. Discontinue rituximab and concomitant medications in the event of HBV reactivation. Screening should include hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc); monitor patients for clinical and laboratory signs of hepatitis or HBV reactivation during and for several months after treatment. If viral hepatitis develops, initiate appropriate antiviral therapy. Reactivation has occurred in patients who are HBsAg positive as well as in those who are HBsAg negative but are anti-HBc positive; HBV reactivation has also been observed in patients who had previously resolved HBV infection. HBV reactivation has been reported up to 24 months after discontinuation. Use cautiously in patients who show evidence of prior HBV infection (eg, HBsAg positive [regardless of antibody status] or HBsAg negative but anti-HBc positive); consult with appropriate clinicians regarding monitoring and consideration of antiviral therapy before and/or during rituximab treatment. The safety of resuming rituximab treatment following HBV reactivation is not known; discuss reinitiation of therapy in patients with resolved HBV reactivation with physicians experienced in HBV management.

- American Society of Clinical Oncology (ASCO) provisional clinical opinion update on hepatitis B virus screening recommendations (Hwang 2015): Patients receiving anti-CD20 antibodies are at high risk for hepatitis B virus (HBV) reactivation. Screen for HBV infection with HBsAg and anti-HBc tests prior to treatment initiation; either a total anti-HBc (with both IgG and IgM) or anti-HBc IgG test should be used to screen for chronic or resolved HBV infection (do not use anti-HBc IgM as it may only confirm acute HBV infection). In addition, patients who have risk factors for HBV infection (eg, birthplace in a country with ≥2% HBV prevalence, household or sexual contact with HBV infected patients, high-risk behaviors [eg, intravenous drug use], and HIV infection) should also be screened prior to beginning therapy. Initiate prophylactic antiviral therapy (utilizing antivirals with low rates of viral resistance) for HBsAg positive/anti-HBc positive patients (without delaying cancer therapy) and continue the antivirals during and for ~6 to 12 months after completing treatment. HBsAg negative/anti-HBc positive patients should be monitored for HBV reactivation with HBV DNA and ALT testing approximately every 3 months during treatment; antiviral therapy may be initiated prophylactically or begun promptly at the first sign of HBV reactivation.

• Infections: Use is not recommended in patients with severe active infection. Serious and potentially fatal bacterial, fungal, and either new or reactivated viral infections may occur during treatment and after completing rituximab. Infections have been observed in patients with prolonged hypogammaglobulinemia, defined as hypogammaglobulinemia >11 months after rituximab exposure. Associated new or reactivated viral infections have included cytomegalovirus, herpes simplex virus, parvovirus B19, varicella zoster virus, West Nile virus, and hepatitis B and C. Discontinue rituximab (and concomitant chemotherapy) in patients who develop viral hepatitis and initiate antiviral therapy. Discontinue rituximab in patients who develop other serious infections and initiate appropriate anti-infective treatment.

• Infusion reactions: [US Boxed Warning]: Serious (including fatal) infusion-related reactions have been reported, usually with the first infusion; fatalities have been reported within 24 hours of infusion; monitor closely during infusion; discontinue for severe reactions and provide medical intervention for grades 3 or 4 infusion reactions. Reactions usually occur within 30 to 120 minutes and may include hypotension, angioedema, bronchospasm, hypoxia, urticaria, and in more severe cases pulmonary infiltrates, acute respiratory distress syndrome, myocardial infarction, ventricular fibrillation, cardiogenic shock, and/or anaphylactoid events. Closely monitor patients with a history of prior cardiopulmonary reactions or with preexisting cardiac or pulmonary conditions and patients with high numbers of circulating malignant cells (>25,000/mm3). Prior to infusion, premedicate patients with acetaminophen and an antihistamine (and methylprednisolone for patients with RA). Medications for the treatment of hypersensitivity reactions (eg, bronchodilators, epinephrine, corticosteroids, oxygen) should be available for immediate use; treatment is symptomatic. If infusion reaction occurs, temporarily or permanently discontinue infusion (depending on the severity of the reaction and required interventions). After symptoms resolve, infusion may be resumed with at least a 50% infusion rate reduction.

• Mucocutaneous reactions: [US Boxed Warning]: Severe and sometimes fatal mucocutaneous reactions (lichenoid dermatitis, paraneoplastic pemphigus, Stevens-Johnson syndrome, toxic epidermal necrolysis and vesiculobullous dermatitis) have been reported; onset has been variable but has occurred as early as the first day of exposure. Discontinue in patients experiencing severe mucocutaneous skin reactions; the safety of reexposure following mucocutaneous reactions has not been evaluated.

• Progressive multifocal leukoencephalopathy: [US Boxed Warning]: Progressive multifocal leukoencephalopathy (PML) due to JC virus infection has been reported with rituximab; may be fatal. Cases were reported in patients with hematologic malignancies receiving rituximab either with combination chemotherapy, or with hematopoietic stem cell transplant. Cases were also reported in patients receiving rituximab for autoimmune diseases who had received concurrent or prior immunosuppressant therapy. Onset may be delayed, although most cases were diagnosed within 12 months of the last rituximab dose. A retrospective analysis of patients (n=57) diagnosed with PML following rituximab therapy, found a median of 16 months (following rituximab initiation), 5.5 months (following last rituximab dose), and 6 rituximab doses preceded PML diagnosis. Clinical findings included confusion/disorientation, motor weakness/hemiparesis, altered vision/speech, and poor motor coordination with symptoms progressing over weeks to months (Carson 2009). Promptly evaluate any patient presenting with neurological changes; consider neurology consultation, brain MRI and lumbar puncture for suspected PML. Discontinue rituximab in patients who develop PML; consider reduction/discontinuation of concurrent chemotherapy or immunosuppressants.

• Renal toxicity: May cause fatal renal toxicity in patients with NHL. Patients who received combination therapy with cisplatin and rituximab for NHL experienced renal toxicity during clinical trials; this combination is not an approved treatment regimen. Renal toxicity also occurred due to tumor lysis syndrome. Monitor for signs of renal failure; discontinue rituximab with increasing serum creatinine or oliguria.

• Tumor lysis syndrome: Tumor lysis syndrome leading to acute renal failure requiring dialysis (some fatal) may occur within 12 to 24 hours following the first dose when used as a single agent in the treatment of NHL. Hyperkalemia, hypocalcemia, hyperuricemia, and/or hyperphosphatemia may occur. Administer prophylaxis (antihyperuricemic therapy, aggressive hydration) in patients at high risk (high numbers of circulating malignant cells ≥25,000/mm3 or high tumor burden). Correct electrolyte abnormalities; monitor renal function and hydration status, and administer supportive care as indicated.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

• Immunizations: Live vaccines should not be given concurrently with rituximab; there is no data available concerning secondary transmission of live vaccines with or following rituximab treatment. Rheumatoid arthritis patients should be brought up to date with nonlive immunizations (following current guidelines) at least 4 weeks before initiating therapy; response to some immunizations may be lower in some patients receiving rituximab.

Special populations:

• Elderly: Use with caution in the elderly. There is a higher risk of cardiac (supraventricular arrhythmia) and pulmonary adverse events (pneumonia, pneumonitis) and the incidence of serious infections and/or grade 3 or 4 adverse reactions are higher in elderly patients.

• Granulomatosis with polyangiitis (GPA; Wegener granulomatosis)/microscopic polyangiitis (MPA): The safety of concomitant immunosuppressants other than corticosteroids has not been evaluated in patients with GPA or MPA after rituximab-induced B-cell depletion. There are only limited data on subsequent courses of rituximab for GPA or MPA; safety and efficacy of re-treatment have not been established.

• Rheumatoid arthritis: There are limited data on the safety of other biologics or disease-modifying antirheumatic drugs (DMARDs) other than methotrexate in patients with rheumatoid arthritis with B-cell depletion following rituximab treatment. Monitor patients closely for infection if biologic agents or DMARDS are used concomitantly. The use of rituximab is not recommended in RA patients who have not had prior inadequate response to one or more TNF antagonists.

Dosage form specific issues:

• Administration: Rituximab is for IV administration only. Do not substitute rituximab and hyaluronidase (SubQ) for rituximab (IV). Use caution during product selection, preparation, and administration.

• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade 1986; CDC 1984). See manufacturer's labeling.

Metabolism/Transport Effects

None known.

Drug Interactions

(For additional information: Launch drug interactions program)

Abatacept: RiTUXimab may enhance the adverse/toxic effect of Abatacept. Risk X: Avoid combination

BCG (Intravesical): Immunosuppressants may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

BCG (Intravesical): Myelosuppressive Agents may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

Belimumab: Monoclonal Antibodies may enhance the adverse/toxic effect of Belimumab. Risk X: Avoid combination

Certolizumab Pegol: RiTUXimab may enhance the immunosuppressive effect of Certolizumab Pegol. Risk X: Avoid combination

Chloramphenicol (Ophthalmic): May enhance the adverse/toxic effect of Myelosuppressive Agents. Risk C: Monitor therapy

CloZAPine: Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for neutropenia may be increased. Risk C: Monitor therapy

Coccidioides immitis Skin Test: Immunosuppressants may diminish the diagnostic effect of Coccidioides immitis Skin Test. Risk C: Monitor therapy

Deferiprone: Myelosuppressive Agents may enhance the neutropenic effect of Deferiprone. Risk X: Avoid combination

Denosumab: May enhance the adverse/toxic effect of Immunosuppressants. Specifically, the risk for serious infections may be increased. Risk C: Monitor therapy

Dipyrone: May enhance the adverse/toxic effect of Myelosuppressive Agents. Specifically, the risk for agranulocytosis and pancytopenia may be increased Risk X: Avoid combination

Echinacea: May diminish the therapeutic effect of Immunosuppressants. Risk D: Consider therapy modification

Fingolimod: Immunosuppressants may enhance the immunosuppressive effect of Fingolimod. Management: Avoid the concomitant use of fingolimod and other immunosuppressants when possible. If combined, monitor patients closely for additive immunosuppressant effects (eg, infections). Risk D: Consider therapy modification

Leflunomide: Immunosuppressants may enhance the adverse/toxic effect of Leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Management: Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Patients receiving both leflunomide and another immunosuppressant should be monitored for bone marrow suppression at least monthly. Risk D: Consider therapy modification

Natalizumab: Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased. Risk X: Avoid combination

Nivolumab: Immunosuppressants may diminish the therapeutic effect of Nivolumab. Risk D: Consider therapy modification

Ocrelizumab: May enhance the immunosuppressive effect of Immunosuppressants. Risk C: Monitor therapy

Pidotimod: Immunosuppressants may diminish the therapeutic effect of Pidotimod. Risk C: Monitor therapy

Pimecrolimus: May enhance the adverse/toxic effect of Immunosuppressants. Risk X: Avoid combination

Promazine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk C: Monitor therapy

Roflumilast: May enhance the immunosuppressive effect of Immunosuppressants. Risk D: Consider therapy modification

Sipuleucel-T: Immunosuppressants may diminish the therapeutic effect of Sipuleucel-T. Risk C: Monitor therapy

Tacrolimus (Topical): May enhance the adverse/toxic effect of Immunosuppressants. Risk X: Avoid combination

Tertomotide: Immunosuppressants may diminish the therapeutic effect of Tertomotide. Risk C: Monitor therapy

Tofacitinib: RiTUXimab may enhance the adverse/toxic effect of Tofacitinib. Risk X: Avoid combination

Trastuzumab: May enhance the neutropenic effect of Immunosuppressants. Risk C: Monitor therapy

Vaccines (Inactivated): Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting an immunosuppressant. If vaccinated during immunosuppressant therapy, revaccinate at least 3 months after immunosuppressant discontinuation. Risk D: Consider therapy modification

Vaccines (Live): Immunosuppressants may enhance the adverse/toxic effect of Vaccines (Live). Immunosuppressants may diminish the therapeutic effect of Vaccines (Live). Management: Avoid use of live organism vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants. Risk X: Avoid combination

Pregnancy Risk Factor

C (show table)

Pregnancy Implications

Animal reproduction studies have demonstrated adverse effects including decreased (reversible) B-cells and immunosuppression. Rituximab crosses the placenta and can be detected in the newborn. In one infant born at 41 weeks' gestation, in utero exposure occurred from week 16 to 37; rituximab concentrations were higher in the neonate at birth (32,095 ng/mL) than the mother (9,750 ng/mL) and still measurable at 18 weeks of age (700 ng/mL infant; 500 ng/mL mother) (Friedrichs 2006).

B-cell lymphocytopenia lasting <6 months may occur in exposed infants. Retrospective case reports of inadvertent pregnancy during rituximab treatment collected by the manufacturer (often combined with concomitant teratogenic therapies) describe premature births and infant hematologic abnormalities and infections; no specific pattern of birth defects has been observed (limited data) (Chakravarty 2010).

Effective contraception should be used in women of reproductive potential during and for 12 months following treatment with rituximab.

The European Society for Medical Oncology has published guidelines for diagnosis, treatment, and follow-up of cancer during pregnancy. The guidelines recommend referral to a facility with expertise in cancer during pregnancy and encourage a multidisciplinary team (obstetrician, neonatologist, oncology team). Based on limited data, if pregnancy occurs during rituximab treatment, the pregnancy may continue provided rituximab treatment is withheld. In general, although the risk of B-cell depletion in the newborn is increased, if postponing rituximab treatment would significantly compromise maternal outcome in patients diagnosed with B-cell lymphoma during pregnancy, rituximab use is not discouraged during the pregnancy (Peccatori 2013). An international consensus panel has published guidelines for hematologic malignancies during pregnancy. In patients with aggressive lymphomas, rituximab (as a component of the R-CHOP chemotherapy regimen) may be administered in the second and third trimesters, however, the cytotoxic portion of the regimen should not be administered within 3 weeks prior to anticipated delivery (Lishner 2016).

Other agents are preferred for treating lupus nephritis in pregnant women (Hahn 2012). When treating rheumatoid arthritis, it is recommended to discontinue use and switch to a safer medication prior to conception unless no other pregnancy compatible medication is able to control maternal disease (Götestam Skorpen 2016).

Data collection to monitor pregnancy and infant outcomes following exposure to rituximab is ongoing. A pregnancy registry is available for all cancers diagnosed during pregnancy at Cooper Health (877-635-4499).

Breast-Feeding Considerations

It is not known if rituximab is present in human milk. However, human IgG is excreted in breast milk, and therefore, rituximab may also be excreted in milk. Although rituximab would not be expected to enter the circulation of a breastfed infant in significant amounts, the unknown risks to the breastfed infant from oral rituximab ingestion should be weighed against the known benefits of breastfeeding. When treating rheumatoid arthritis, it is recommended to avoid breastfeeding during therapy unless no other compatible medication is able to control maternal disease. Breastfeeding should not be discouraged if no other agent is available (Götestam Skorpen 2016).

Monitoring Parameters

CBC with differential and platelets (obtain prior to treatment and at weekly to monthly intervals and more frequently in patients with lymphoid malignancies, or at 2- to 4-month intervals in rheumatoid arthritis patients, GPA and MPA), electrolytes (in patients at risk for TLS), renal function (in patients at risk for TLS), fluid/hydration status balance; blood pressure, vital signs.

Screen all patients for HBV infection prior to therapy initiation (eg, HBsAG and anti-HBc measurements). In addition, carriers and patients with evidence of current infection or recovery from prior hepatitis B infection should be monitored closely for clinical and laboratory signs of HBV reactivation and/or infection during therapy and for up to 2 years following completion of treatment. Hepatitis B virus (HBV) screening recommendations (ASCO provisional clinical opinion update [Hwang 2015]): Screen for HBV infection with hepatitis B surface antigen (HBsAG) and hepatitis B core antibody (anti-HBc) tests prior to treatment initiation; either a total anti-HBc (with both IgG and IgM) or anti-HBc IgG test should be used to screen for chronic or resolved HBV infection (do not use anti-HBc IgM as it may only confirm acute HBV infection). HBsAg negative/anti-HBc positive patients should be monitored for HBV reactivation with HBV DNA and ALT testing approximately every 3 months during treatment.

Monitor for infusion reactions; signs of active hepatitis B infection (during and for up to 12 months after therapy completion); cardiac monitoring during and after infusion (in rheumatoid arthritis patients and in patients with pre-existing cardiac disease or if arrhythmias develop during or after subsequent infusions); monitor for signs/symptoms of bowel obstruction/perforation (abdominal pain, vomiting); signs or symptoms of progressive multifocal leukoencephalopathy (focal neurologic deficits, which may present as hemiparesis, visual field deficits, cognitive impairment, aphasia, ataxia, and/or cranial nerve deficits); if PML is suspected, obtain brain MRI scan and lumbar puncture; signs/symptoms of TLS and/or mucocutaneous skin reactions.

Mechanism of Action

Rituximab is a monoclonal antibody directed against the CD20 antigen on the surface of B-lymphocytes. CD20 regulates cell cycle initiation; and, possibly, functions as a calcium channel. Rituximab binds to the antigen on the cell surface, activating complement-dependent B-cell cytotoxicity; and to human Fc receptors, mediating cell killing through an antibody-dependent cellular toxicity. B-cells are believed to play a role in the development and progression of rheumatoid arthritis. Signs and symptoms of RA are reduced by targeting B-cells and the progression of structural damage is delayed.

Pharmacodynamics/Kinetics

Onset:

Immune thrombocytopenia: Initial response: 7 to 56 days; Peak response: 14 to 180 days (Neunert 2011).

NHL: B-cell depletion: Within 3 weeks.

Rheumatoid arthritis (RA): B-cell depletion: Within 2 weeks.

Duration:

NHL: Detectable in serum 3 to 6 months after completion of treatment; B-cell depletion is sustained for up to 6 to 9 months and B-cell recovery begins ~6 months following completion of treatment; median B-cell levels return to normal by 12 months following completion of treatment

RA: B-cell depletion persists for at least 6 months.

Distribution: RA: 3.1 L; GPA/MPA: 4.5 L

Half-life elimination:

CLL: Median terminal half-life: 32 days (range: 14 to 62 days)

NHL: Median terminal half-life: 22 days (range: 6 to 52 days)

RA: Mean terminal half-life: 18 days (range: 5 to 78 days)

GPA/MPA: 23 days (range: 9 to 49 days)

Pricing: US

Solution (Rituxan Intravenous)

100 mg/10 mL (10 mL): $1,084.06

500 mg/50 mL (50 mL): $5,420.28

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International
  • Blitzima (CZ);
  • Mabtera (UA);
  • Mabthera (AE, AR, AT, AU, BB, BE, BF, BG, BH, BJ, BM, BR, BS, BZ, CH, CI, CL, CN, CO, CR, CU, CY, CZ, DE, DK, DO, EC, EE, EG, ES, ET, FI, FR, GB, GH, GM, GN, GR, GT, GY, HK, HN, HR, HU, IE, IL, IS, IT, JM, JO, KE, KR, KW, LB, LK, LR, LT, LU, LV, MA, ML, MR, MT, MU, MW, MX, MY, NE, NG, NI, NL, NO, NZ, PA, PE, PH, PK, PL, PT, PY, QA, RO, RU, SA, SC, SD, SE, SG, SI, SK, SL, SN, SR, SV, TH, TN, TR, TT, TW, TZ, UG, UY, VE, VN, ZA, ZM, ZW);
  • Mabthera SC (HK, MY, TH);
  • Reditux (IN, LK, VN);
  • Relito (BD);
  • Rituxan (JP);
  • Rituxim (BD)
Use of UpToDate is subject to the Subscription and License Agreement.

REFERENCES

  1. Advani RH and Hoppe RT. How I treat nodular lymphocyte predominant Hodgkin lymphoma. Blood. 2013;122(26):4182-4188. [PubMed 24215035]
  2. Advani RH, Horning SJ, Hoppe RT, et al. Mature results of a phase II study of rituximab therapy for nodular lymphocyte-predominant Hodgkin lymphoma. J Clin Oncol. 2014;32(9):912-918. [PubMed 24516013]
  3. Ahmed AR, Spigelman Z, Cavacini LA, et al, “Treatment of Pemphigus Vulgaris With Rituximab and Intravenous Immune Globulin,” N Engl J Med, 2006, 355(17):1772-9. [PubMed 17065638]
  4. Alade SL, Brown RE, Paquet A Jr. Polysorbate 80 and E-Ferol toxicity. Pediatrics. 1986;77(4):593-597. [PubMed 3960626]
  5. Arnold DM, Dentali F, Crowther MA, et al, “Systematic Review: Efficacy and Safety of Rituximab for Adults With Idiopathic Thrombocytopenic Purpura,” Ann Intern Med, 2007, 146(1):25-33. [PubMed 17200219]
  6. Avivi I, Robinson S, and Goldstone A, “Clinical Use of Rituximab in Haematological Malignancies,” Br J Cancer, 2003, 89(8):1389-94. [PubMed 14562003]
  7. Barcellini W, Zaja F, Zaninoni A, et al, “Low-dose Rituximab in Adult Patients With Idiopathic Autoimmune Hemolytic Anemia: Clinical Efficacy and Biologic Studies,” Blood, 2012, 119(16):3691-7. [PubMed 22267606]
  8. Barth MJ, Goldman S, Smith L, et al. Rituximab pharmacokinetics in children and adolescents with de novo intermediate and advanced mature B-cell lymphoma/leukaemia: a Children's Oncology Group report. Br J Haematol. 2013;162(5):678-683. [PubMed 23802659]
  9. Bertsias GK1, Tektonidou M, Amoura Z, et al. Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 2012;71(11):1771-1782. [PubMed 22851469]
  10. Boye J, Elter T, and Engert A, “An Overview of the Current Clinical Use of the Anti-CD20 Monoclonal Antibody Rituximab,” Ann Oncol, 2003, 14(4):520-35. [PubMed 12649096]
  11. Caramazza D, Quintini G, Abbene I, et al, “Relapsing or Refractory Idiopathic Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome: The Role of Rituximab,” Transfusion, 2010, 50(12):2753-60. [PubMed 20576013]
  12. Carson KR, Evens AM, Richey EA, et al, “Progressive Multifocal Leukoencephalopathy After Rituximab Therapy in HIV-Negative Patients: A Report of 57 Cases From the Research on Adverse Drug Events and Reports Project,” Blood, 2009, 113(20):4834-40. [PubMed 19264918]
  13. Centers for Disease Control (CDC). Unusual syndrome with fatalities among premature infants: association with a new intravenous vitamin E product. MMWR Morb Mortal Wkly Rep. 1984;33(14):198-199. http://www.cdc.gov/mmwr/preview/mmwrhtml/00000319.htm. [PubMed 6423951]
  14. Chakravarty EF, Murray ER, Kelman A, et al, “Pregnancy Outcomes Following Maternal Exposure to Rituximab,” Blood, 2011, 117(5):1499-506. [PubMed 21098742]
  15. Cholera M and Chainani-Wu N. Management of pemphigus vulgaris. Adv Ther. 2016;33(6):910-958. [PubMed 27287854]
  16. Choquet S, Leblond V, Herbrecht R, et al, “Efficacy and Safety of Rituximab in B-Cell Post-Transplantation Lymphoproliferative Disorders: Results of a Prospective Multicenter Phase 2 Study,” Blood, 2006, 107(8):3053-7. [PubMed 16254143]
  17. Coiffier B, “State-of-the-Art Therapeutics: Diffuse Large B-Cell Lymphoma,” J Clin Oncol, 2005, 23(26): 6387-93.
  18. Coiffier B, Haioun C, Ketterer N, et al, “Rituximab (Anti-CD20 Monoclonal Antibody) for the Treatment of Patients With Relapsing or Refractory Aggressive Lymphoma: A Multicenter Phase II Study,” Blood, 1998, 92(6):1927-32. [PubMed 9731049]
  19. Coiffier B, Lepage E, Briere J, “CHOP Chemotherapy Plus Rituximab Compared With CHOP Alone in Elderly Patients With Diffuse Large-B-Cell Lymphoma,” N Engl J Med, 2002, 346(4):235-42. [PubMed 11807147]
  20. Colvin MM, Cook JL, Chang P, et al; American Heart Association Heart Failure and Transplantation Committee of the Council on Clinical Cardiology; American Heart Association Heart Failure and Transplantation Committee of the Council on Cardiopulmonary Critical Care, Perioperative and Resuscitation; American Heart Association Heart Failure and Transplantation Committee of the Council on Cardiovascular Disease in the Young; et al. Antibody-mediated rejection in cardiac transplantation: emerging knowledge in diagnosis and management: a scientific statement from the American Heart Association. Circulation. 2015;131(18):1608-1639. [PubMed 25838326]
  21. Costanzo MR, Dipchand A, Starling R, et al. International Society of Heart and Lung Transplantation Guidelines. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2010 Aug;29(8):914-56. doi: 10.1016/j.healun.2010.05.034. [PubMed 20643330]
  22. Cutler C, Miklos D, Kim HT, et al, “Rituximab for Steroid-Refractory Chronic Graft-Versus-Host Disease,” Blood, 2006, 108(2):756-62. [PubMed 16551963]
  23. Dahan K, Debiec H, Plaisier E, et al. Rituximab for severe membranous nephropathy: a 6-month trial with extended follow-up [published online ahead of print June 27, 2016]. J Am Soc Nephrol. 2016:pii: ASN.2016040449. [PubMed 27352623]
  24. Damato V, Evoli A, Iorio R. Efficacy and safety of rituximab therapy in neuromyelitis optica spectrum disorders: a systematic review and meta-analysis. JAMA Neurol. 2016;73(11):1342-1348. [PubMed 27668357]
  25. Dello Strologo L, Guzzo I, Laurenzi C, et al, “Use of Rituximab in Focal Glomerulosclerosis Relapses After Renal Transplantation,” Transplantation, 2009, 88(3):417-20. [PubMed 19667947]
  26. DHHS Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Department of Health and Human Services. November 2013. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/oi_guidelines_pediatrics.pdf.
  27. DHHS Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. October 2014. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Accessed November 12, 2014
  28. Diaz-Largares C, Croca S, Sangle S, et al. Efficacy of rituximab in 164 patients with biopsy-proven lupus nephritis: pooled data from European cohorts. Autoimmun Rev. 2012;11(5):357-364. [PubMed 22032879]
  29. Díaz-Manera J, Martínez-Hernández E, Querol L, et al. Long-lasting treatment effect of rituximab in MuSK myasthenia. Neurology. 2012;78(3):189-193. [PubMed 22218276]
  30. Dimopoulos MA, Anagnostopoulos A, Kyrtsonis MC, et al. Primary treatment of Waldenström macroglobulinemia with dexamethasone, rituximab, and cyclophosphamide. J Clin Oncol. 2007;25(22):3344-3349. [PubMed 17577016]
  31. Dimopoulos MA, García-Sanz R, Gavriatopoulou M, et al. Primary therapy of Waldenstrom macroglobulinemia (WM) with weekly bortezomib, low-dose dexamethasone, and rituximab (BDR): long-term results of a phase 2 study of the European Myeloma Network (EMN). Blood. 2013;122(19):3276-3282. [PubMed 24004667]
  32. Dimopoulos MA, Kyle RA, Anagnostopoulos A, et al, “Diagnosis and Management of Waldenstrom's Macroglobulinemia,” J Clin Oncol, 2005, 23(7):1564-1577. [PubMed 15735132]
  33. Dimopoulos MA, Zervas C, Zomas A, et al, “Treatment of Waldenstrom’s Macroglobulinemia With Rituximab,” J Clin Oncol, 2002, 20(9):2327-2333. [PubMed 11981004]
  34. Edwards JC, Szczepanski L, Szechinski J, et al, “Efficacy of B-Cell-Targeted Therapy With Rituximab in Patients With Rheumatoid Arthritis,” N Engl J Med, 2004, 350(25):2572-2581. [PubMed 15201414]
  35. Ekstrand BC, Lucas JB, Horwitz SM, et al, “Rituximab in Lymphocyte-Predominant Hodgkin Disease: Results of a Phase 2 Trial,” Blood, 2003;101(11):4285-9. [PubMed 12586628]
  36. El Tal AK, Posner MR, Spigelman Z, et al. Rituximab: a monoclonal antibody to CD20 used in the treatment of pemphigus vulgaris. J Am Acad Dermatol. 2006;55(3):449-459. [PubMed 16908351]
  37. Else M, Marín-Niebla A, de la Cruz F, et al. Rituximab, used alone or in combination, is superior to other treatment modalities in splenic marginal zone lymphoma. Br J Haematol. 2012;159(3):322-328. [PubMed 23016878]
  38. Enting RH, Demopoulos A, DeAngelis LM, et al. Salvage therapy for primary CNS lymphoma with a combination of rituximab and temozolomide. Neurology. 2004;63(5):901-903. [PubMed 15365145]
  39. Fervenza FC, Abraham RS, Erickson SB, et al, “Rituximab Therapy in Idiopathic Membranous Nephropathy: A 2-Year Study,” Clin J Am Soc Nephrol, 2010, 5(12):2188-98. [PubMed 20705965]
  40. Fervenza FC, Cosio FG, Erickson SB, et al, “Rituximab Treatment of Idiopathic Membranous Nephropathy,” Kidney Int, 2008, 73(1):117-25. [PubMed 17943078]
  41. Friedrichs B, Tiemann M, Salwender H, et al. The effects of rituximab treatment during pregnancy on a neonate. Haematologica. 2006;91(10):1426-1427. [PubMed 16963391]
  42. Fujinaga S, Hirano D, Nishizaki N, et al, “Single Infusion of Rituximab for Persistent Steroid-Dependent Minimal-Change Nephrotic Syndrome After Long-Term Cyclosporine,” Pediatr Nephrol, 2010, 25(3):539-44. [PubMed 20049616]
  43. Furman RR, Sharman JP, Coutre Se, et al. Idelalisib and rituximab in relapsed chronic lymphocytic leukemia. N Engl J Med. 2014;370(11):997-1007. [PubMed 24450857]
  44. Garcia-Suarez J, de Miguel D, Krsnik I, et al, “Changes in the Natural History of Progressive Multifocal Leukoencephalopathy in HIV-Negative Lymphoproliferative Disorders: Impact of Novel Therapies,” Am J Hematol, 2005, 80(4):271-81. [PubMed 16315252]
  45. Ghobrial IM, Hong F, Padmanabhan S, et al. Phase II trial of weekly bortezomib in combination with rituximab in relapsed or relapsed and refractory Waldenstrom macroglobulinemia. J Clin Oncol. 2010;28(8):1422-1428. [PubMed 20142586]
  46. Gisselbrecht C, Glass B, Mounier N, et al, "Salvage Regimens With Autologous Transplantation for Relapsed Large B-Cell Lymphoma in the Rituximab Era," J Clin Oncol, 2010, 28(27):4184-90. [PubMed 20660832]
  47. Gobert D, Bussel JB, Cunningham-Rundles C, et al. Efficacy and safety of rituximab in common variable immunodeficiency-associated immune cytopenias: a retrospective multicentre study on 33 patients. Br J Haematol. 2011;155(4):498-508. [PubMed 21981575]
  48. Godeau B, Porcher R, Fain O, et al, “Rituximab Efficacy and Safety in Adult Splenectomy Candidates With Chronic Immune Thrombocytopenic Purpura: Results of a Prospective Multicenter Phase 2 Study,” Blood, 2008, 112(4):999-1004. [PubMed 18463354]
  49. Goldberg SL, Pecora AL, Alter RS, et al, “Unusual Viral Infections (Progressive Multifocal Leukoencephalopathy and Cytomegalovirus Disease) After High-Dose Chemotherapy With Autologous Blood Stem Cell Rescue and Peritransplantation Rituximab,” Blood, 2002, 99(4):1486-8. [PubMed 11830505]
  50. Götestam Skorpen C, Hoeltzenbein M, Tincani A, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016;75(5):795-810. doi: 10.1136/annrheumdis-2015-208840. [PubMed 26888948]
  51. Gottenberg JE, Guillevin L, Lambotte O, et al, “Tolerance and Short Term Efficacy of Rituximab in 43 Patients With Systemic Autoimmune Diseases,” Ann Rheum Dis, 2005, 64(6):913-20. [PubMed 15550531]
  52. Gregory G, Arumugaswamy A, Leung T, et al. Rituximab is associated with improved survival for aggressive B cell CNS lymphoma. Neuro Oncol. 2013;15(8):1068-1073. [PubMed 23502429]
  53. Grillo-Lopez AJ, “Rituximab (Rituxan/MabThera): The First Decade (1993-2003),” Expert Rev Anticancer Ther, 2003, 3(6):767-79. [PubMed 14686699]
  54. Guigonis V, Dallocchio A, Baudouin V, et al, “Rituximab Treatment for Severe Steroid- or Cyclosporine-Dependent Nephrotic Syndrome: A Multicentric Series of 22 Cases,” Pediatr Nephrol, 2008, 23(8):1269-79. [PubMed 18465150]
  55. Hahn BH, McMahon MA, Wilkinson A, et al, "American College of Rheumatology Guidelines for Screening, Treatment, and Management of Lupus Nephritis," Arthritis Care Res (Hoboken), 2012, 64(6):797-808. [PubMed 22556106]
  56. Higashida J, Wun T, Schmidt S, et al, “Safety and Efficacy of Rituximab in Patients With Rheumatoid Arthritis Refractory to Disease Modifying Antirheumatic Drugs and Anti-Tumor Necrosis Factor-Alpha Treatment,” J Rheumatol, 2005, 32(11):2109-15. [PubMed 16265687]
  57. Hoelzer D, Walewski J, Döhner H, et al. Improved outcome of adult Burkitt lymphoma/leukemia with rituximab and chemotherapy: report of a large prospective multicenter trial. Blood. 2014;124(26):3870-3879. [PubMed 25359988]
  58. Holdhoff M, Ambady P, Abdelaziz A, et al. High-dose methotrexate with or without rituximab in newly diagnosed primary CNS lymphoma. Neurology. 2014;83(3):235-239. [PubMed 24928128]
  59. Hwang JP, Somerfield MR, Alston-Johnson DE, et al. Hepatitis B Virus Screening for Patients With Cancer Before Therapy: American Society of Clinical Oncology Provisional Clinical Opinion Update. J Clin Oncol. 2015;33(19):2212-2220. [PubMed 25964247]
  60. Isaksson M, Jansson L. Contact allergy to Tween 80 in an inhalation suspension. Contact Dermatitis. 2002;47(5):312-313. [PubMed 12534540]
  61. Johnson P and Glennie M, “The Mechanisms of Action of Rituximab in the Elimination of Tumor Cells,” Semin Oncol, 2003, 30(1 Suppl 2):3-8.
  62. Joly P, Maho-Vaillant M, Prost-Squarcioni C, et al. First-line rituximab combined with short-term prednisone versus prednisone alone for the treatment of pemphigus (Ritux 3): a prospective, multicentre, parallel-group, open-label randomised trial. Lancet. 2017;389(10083):2031-2040. [PubMed 28342637]
  63. Jones RB, Tervaert JW, Hauser T, et al, “Rituximab Versus Cyclophosphamide in ANCA-Associated Renal Vasculitis,” N Engl J Med, 2010, 363(3):211-20. [PubMed 20647198]
  64. Kaito H, Kamei K, Kikuchi E, et al, “Successful Treatment of Collapsing Focal Segmental Glomerulosclerosis With a Combination of Rituximab, Steroids, and Ciclosporin,” Pediatr Nephrol, 2010, 25(5):957-9. [PubMed 20033219]
  65. Kalpadakis C, Pangalis GA, Angelopoulou MK, et al. Treatment of splenic marginal zone lymphoma with rituximab monotherapy: progress report and comparison with splenectomy. Oncologist. 2013;18(2):190-197. [PubMed 23345547]
  66. Kasperkiewicz M, Shimanovich I, Ludwig RJ, et al. Rituximab for treatment-refractory pemphigus and pemphigoid: a case series of 17 patients. J Am Acad Dermatol. 2011;65(3):552-558. [PubMed 21641080]
  67. Keating MJ, O’Brien S, Albitar M, et al, “Early Results of a Chemoimmunotherapy Regimen of Fludarabine, Cyclophosphamide, and Rituximab as Initial Therapy for Chronic Lymphocytic Leukemia,” J Clin Oncol, 2005, 23(18):4079-88. [PubMed 15767648]
  68. Ketterer N, Coiffier B, Thieblemont C,et al, Phase III study of ACVBP versus ACVBP plus rituximab for patients with localized low-risk diffuse large B-cell lymphoma (LNH03-1B). Ann Oncol. 2013;24(4):1032-1037. [PubMed 23235801]
  69. Kim SJ, Lee JW, Jung CW, et al, "Weekly Rituximab Followed by Monthly Rituximab Treatment for Steroid-Refractory Chronic Graft-Versus-Host Disease: Results From a Prospective, Multicenter, Phase II Study," Haematologica, 2010, 95(11):1935-42. [PubMed 20663943]
  70. Leblond V, Kastritis E, Advani R, et al. Treatment recommendations from the Eighth International Workshop on Waldenström's Macroglobulinemia. Blood. 2016;128(10):1321-1328. [PubMed 27432877]
  71. Lechner K and Jäger U. How I treat autoimmune hemolytic anemias in adults. Blood. 2010;116(11):1831-1838. [PubMed 20548093]
  72. Lishner M, Avivi I, Apperley JF, et al. Hematologic Malignancies in Pregnancy: Management Guidelines From an International Consensus Meeting. J Clin Oncol. 2016;34(5):501-508. [PubMed 26628463]
  73. Lucente P, Iorizzo M, Pazzaglia M. Contact sensitivity to Tween 80 in a child. Contact Dermatitis. 2000;43(3):172. [PubMed 10985636]
  74. Maloney DG, Smith B, and Rose A, “Rituximab: Mechanism of Action and Resistance,” Semin Oncol, 2002, 29(1 Suppl 2):2-9.
  75. Marcus R, Imrie K, Belch A, et al, “CVP Chemotherapy Plus Rituximab Compared With CVP as First-Line Treatment for Advanced Follicular Lymphoma,” Blood, 2005, 105(4):1417-23. [PubMed 15494430]
  76. Marks SD, Patey S, Brogan PA, et al, “B Lymphocyte Depletion Therapy in Children With Refractory Systemic Lupus Erythematosus,” Arthritis Rheum, 2005, 52(10):3168-74. [PubMed 16200620]
  77. Martinelli G, Laszlo D, Ferreri AJ, et al. Clinical activity of rituximab in gastric marginal zone non-Hodgkin's lymphoma resistant to or not eligible for anti-Helicobacter pylori therapy. J Clin Oncol. 2005;23(9):1979-1983. [PubMed 15668468]
  78. McDonald V, Manns K, Mackie IJ, Machin SJ, Scully MA. Rituximab pharmacokinetics during the management of acute idiopathic thrombotic thrombocytopenic purpura. J Thromb Haemost. 2010;8(6):1201-1208.
  79. McLaughlin P, Grillo-Lopez AJ, Link BK, et al, “Rituximab Chimeric Anti-CD20 Monoclonal Antibody Therapy for Relapsed Indolent Lymphoma: Half of Patients Respond to a Four-Dose Treatment Program,” J Clin Oncol, 1998, 16(8):2825-33. [PubMed 9704735]
  80. Mealy MA, Wingerchuk DM, Palace J, et al. Comparison of relapse and treatment failure rates among patients with neuromyelitis optica: multicenter study of treatment efficacy. JAMA Neurol. 2014;71(3):324-330. [PubMed 24445513]
  81. Melander C, Sallée M, Trolliet P, et al, “Rituximab in Severe Lupus Nephritis: Early B-Cell Depletion Affects Long-Term Renal Outcome,” Clin J Am Soc Nephrol, 2009, 4(3):579-87. [PubMed 19261822]
  82. Milpied N, Vasseur B, Parquet N, et al, “Humanized Anti-CD20 Monoclonal Antibody (Rituximab) in Post Transplant B-Lymphoproliferative Disorder: A Retrospective Analysis on 32 Patients,” Ann Oncol, 2000, 11(Suppl 1):113-6. [PubMed 10707791]
  83. Moore J, Ma D, Will R, et al, “A Phase II Study of Rituximab in Rheumatoid Arthritis Patients With Recurrent Disease Following Haematopoietic Stem Cell Transplantation,” Bone Marrow Transplant, 2004, 34(3):241-7 [PubMed 15235579]
  84. Neunert C, Lim W, Crowther M, et al. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117(16):4190-4207. [PubMed 21325604]
  85. Ng CM, Bruno R, Combs D, et al, “Population Pharmacokinetics of Rituximab (Anti-CD20 Monoclonal Antibody) in Rheumatoid Arthritis Patients During a Phase II Clinical Trial,” J Clin Pharmacol, 2005, 45(7):792-801. [PubMed 15951469]
  86. Olszewski AJ and Castill JJ. Comparative outcomes of oncologic therapy in gastric extranodal marginal zone (MALT) lymphoma: analysis of the SEER-Medicare database. Ann Oncol. 2013;24(5):1352-1359. [PubMed 23348804]
  87. Panayi GS, “B Cell-Directed Therapy in Rheumatoid Arthritis - Clinical Experience,” J Rheumatol Suppl, 2005, 73:19-24. [PubMed 15693112]
  88. Parodi E, Rivetti E, Amendola G, et al, “Long-Term Follow-Up Analysis After Rituximab Therapy in Children With Refractory Symptomatic ITP: Identification of Factors Predictive of a Sustained Response,” Br J Haematol, 2009, 144(4):552-8. [PubMed 19036077]
  89. Patel VL, Mahevas M, Lee SY, et al, “Outcomes 5 Years After Response to Rituximab Therapy in Children and Adults With Immune Thrombocytopenia,” Blood, 2012, 119(25):5989-95. [PubMed 22566601]
  90. Peccatori FA, Azim HA Jr, Orecchia R, et al. Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi160-vi167. [PubMed 23813932]
  91. Pfreundschuh M, Kuhnt E, Trümper L, et al, “CHOP-like Chemotherapy With or Without Rituximab in Young Patients With Good-Prognosis Diffuse Large-B-Cell Lymphoma: 6-Year Results of an Open-Label Randomised Study of the MabThera International Trial (MInT) Group,” Lancet Oncol, 2011, 12(11):1013-22. [PubMed 21940214]
  92. Provan D, Stasi R, Newland AC, et al, “International Consensus Report on the Investigation and Management of Primary Immune Thrombocytopenia,” Blood, 2010, 115(2):168-86. [PubMed 19846889]
  93. Prytula A, Iijima K, Kamei K, et al, “Rituximab in Refractory Nephrotic Syndrome,” Pediatr Nephrol, 2010, 25(3):461-8. [PubMed 20033225]
  94. Rao A, Kelly M, Musselman M, et al. Safety, efficacy, and immune reconstitution after rituximab therapy in pediatric patients with chronic or refractory hematologic autoimmune cytopenias. Pediatr Blood Cancer. 2008;50(4):822-825. [PubMed 17570702]
  95. Reynaud Q, Durieu I, Dutertre M, et al. Efficacy and safety of rituximab in auto-immune hemolytic anemia: A meta-analysis of 21 studies. Autoimmun Rev. 2015;14(4):304-313. [PubMed 25497766]
  96. Rituxan (rituximab) [prescribing information]. South San Francisco, CA: Genentech Inc; March 2016.
  97. Rituxan (rituximab) [product monograph]. Mississauga, Ontario, Canada: Hoffmann-La Roche; October 2014.
  98. Rizzieri DA, Johnson JL, Byrd JC, et al. Improved efficacy using rituximab and brief duration, high intensity chemotherapy with filgrastim support for Burkitt or aggressive lymphomas: cancer and Leukemia Group B study 10 002. Br J Haematol. 2014;165(1):102-111. [PubMed 24428673]
  99. Roumier M, Loustau V, Guillaud C, et al. Characteristics and outcome of warm autoimmune hemolytic anemia in adults: New insights based on a single-center experience with 60 patients. Am J Hematol. 2014;89(9):E150-E155. [PubMed 24847759]
  100. Rubbert-Roth A, Tak PP, Zerbini C, et al, "Efficacy and Safety of Various Repeat Treatment Dosing Regimens of Rituximab in Patients With Active Rheumatoid Arthritis: Results of a Phase III Randomized Study (MIRROR)," Rheumatology (Oxford), 2010, 49(9):1683-93. [PubMed 20463186]
  101. Ruggenenti P, Debiec H, Ruggiero B, et al. Anti-Phospholipase A2 Receptor Antibody Titer Predicts Post-Rituximab Outcome of Membranous Nephropathy. J Am Soc Nephrol. 2015;26(10):2545-2558. [PubMed 25804280]
  102. Ruggenenti P, Cravecic P, Chianca A, et al. Rituximab in idiopathic membranous nephropathy. J Am Soc Nephrol. 2012;23(8):1416-1425. [PubMed 22822077]
  103. Rummel MJ, Al-Batran SE, Kim SZ, et al. Bendamustine plus rituximab is effective and has a favorable toxicity profile in the treatment of mantle cell and low-grade non-Hodgkin's lymphoma. J Clin Oncol. 2005;23(15):3383-3389. [PubMed 15908650]
  104. Sayani FA, Abrams CS. How I treat refractory thrombotic thrombocytopenic purpura. Blood. 2015;125(25):3860-3867. [PubMed 25784681]
  105. Schulz H, Rehwald U, Morschhauser F, et al, “Rituximab in Relapsed Lymphocyte-Predominant Hodgkin Lymphoma: Long-Term Results of a Phase 2 Trial by the German Hodgkin Lymphoma Study Group (GHSG),” Blood, 2008, 111(1):109-11. [PubMed 17938252]
  106. Scully M, Cohen H, Cavenagh J, et al, “Remission in Acute Refractory and Relapsing Thrombotic Thrombocytopenic Purpura Following Rituximab is Associated With a Reduction in IgG Antibodies to ADAMTS-13,” Br J Haematol, 2007, 136(3):451-61. [PubMed 17233847]
  107. Scully M, McDonald V, Cavenagh J, “A Phase 2 Study of the Safety and Efficacy of Rituximab With Plasma Exchange in Acute Acquired Thrombotic Thrombocytopenic Purpura,” Blood, 2011, 118(7):1746-53. [PubMed 21636861]
  108. Sehn LH, Donaldson J, Filewich A, et al, “Rapid Infusion Rituximab in Combination With Corticosteroid-Containing Chemotherapy or as Maintenance Therapy is Well Tolerated and Can Safely be Delivered in the Community Setting,” Blood, 2007, 109(10):4171-3. [PubMed 17244675]
  109. Serinet MO, Jacquenin E, Habes D, et al, “Anti-CD20 Monoclonal Antibody (Rituximab) Treatment for Epstein-Barr Virus-Associated, B-Cell Lymphoproliferative Disease in Pediatric Liver Transplant Recipients,” J Pediatr Gastroenterol Nutr, 2002, 34(4):389-93. [PubMed 11930095]
  110. Sfikakis PP, Boletis JN, and Tsokos GC, “Rituximab Anti-B-Cell Therapy in Systemic Lupus Erythematosus: Pointing to the Future,” Curr Opin Rheumatol, 2005, 17(5):550-7. [PubMed 16093832]
  111. Shah GD, Yahalom J, Correa DD, et al. Combined immunochemotherapy with reduced whole-brain radiotherapy for newly diagnosed primary CNS lymphoma. J Clin Oncol. 2007;25(30):4730-4735. [PubMed 17947720]
  112. Shelley WB, Talanin N, Shelley ED. Polysorbate 80 hypersensitivity. Lancet. 1995;345(8980):1312-1313. [PubMed 7746084]
  113. Singh JA, Furst DE, Bharat A, et al, “2012 Update of the 2008 American College of Rheumatology Recommendations for the Use of Disease-Modifying Antirheumatic Drugs and Biologic Agents in the Treatment of Rheumatoid Arthritis,” Arthritis Care Res (Hoboken), 2012, 64(5):625-39. [PubMed 22473917]
  114. Stone JH, Merkel PA, Spiera R, et al, “Rituximab Versus Cyclophosphamide for ANCA-Associated Vasculitis,” N Engl J Med, 2010, 363(3):221-32. [PubMed 20647199]
  115. Tak PP, Rigby WF, Rubbert-Roth A, et al, "Inhibition of Joint Damage and Improved Clinical Outcomes With Rituximab Plus Methotrexate in Early Active Rheumatoid Arthritis: The IMAGE Trial," Ann Rheum Dis, 2011, 70(1):39-46. [PubMed 20937671]
  116. Tam CS, O’Brien S, Wierda W, et al, “Long-Term Results of the Fludarabine, Cyclophosphamide, and Rituximab Regimen as Initial Therapy of Chronic Lymphocytic Leukemia,” Blood, 2008, 112(4):975-80. [PubMed 18411418]
  117. Tandan R, Hehir MK 2nd, Waheed W, et al. Rituximab treatment of myasthenia gravis: a systematic review. Muscle Nerve. 2017; 56(2):185-196. [PubMed 28164324]
  118. Thomas DA, Faderl S, O'Brien S, et al. Chemoimmunotherapy with hyper-CVAD plus rituximab for the treatment of adult Burkitt and Burkitt-type lymphoma or acute lymphoblastic leukemia. Cancer. 2006;106(7):1569-1580. [PubMed 16502413]
  119. Trappe R, Oertel S, Leblond V, et al. Sequential treatment with rituximab followed by CHOP chemotherapy in adult B-cell post-transplant lymphoproliferative disorder (PTLD): the prospective international multicentre phase 2 PTLD-1 trial. Lancet Oncol. 2012;13(2):196-206. [PubMed 22173060]
  120. Trebst C, Jarius S, Berthele A, et al. Update on the diagnosis and treatment of neuromyelitis optica: recommendations of the Neuromyelitis Optica Study Group (NEMOS). J Neurol. 2014;261(1):1-16. [PubMed 24272588]
  121. Treon SP, Emmanouilides C, Kimby E, et al. Extended rituximab therapy in Waldenström's macroglobulinemia. Ann Oncol. 2005;16(1):132-138. [PubMed 15598950]
  122. Treon SP, Hanzis C, Tripsas C, et al. Bendamustine therapy in patients with relapsed or refractory Waldenström's macroglobulinemia. Clin Lymphoma Myeloma Leuk. 2011;11(1):133-135. [PubMed 21454214]
  123. Treon SP, Ioakimidis L, Soumerai JD, et al. Primary therapy of Waldenström macroglobulinemia with bortezomib, dexamethasone, and rituximab: WMCTG clinical trial 05-180. J Clin Oncol. 2009;27(23):3830-3835. [PubMed 19506160]
  124. Treon SP, Tripsas CK, Meid K, et al. Carfilzomib, rituximab, and dexamethasone (CaRD) treatment offers a neuropathy-sparing approach for treating Waldenstrom’s macroglobulinemia. Blood. 2014;124(4):503-510. [PubMed 24859363]
  125. Tsimberidou AM, Catovsky D, Schlette E, et al. Outcomes in patients with splenic marginal zone lymphoma and marginal zone lymphoma treated with rituximab with or without chemotherapy or chemotherapy alone. Cancer. 2006;107(1):125-135. [PubMed 16700034]
  126. Tun NM, Villani GM. Efficacy of rituximab in acute refractory or chronic relapsing non-familial idiopathic thrombotic thrombocytopenic purpura: a systematic review with pooled data analysis. J Thromb Thrombolysis. 2012;34(3):347-359. [PubMed 22547089]
  127. Vigna-Perez M, Hernández-Castro B, Paredes-Saharopulos O, et al, “Clinical and immunological Effects of Rituximab in Patients With Lupus Nephritis Refractory to Conventional Therapy: A Pilot Study,” Arthritis Res Ther, 2006, 8(3):R83. [PubMed 16677395]
  128. Waldman M and Austin HA 3rd, “Treatment of Idiopathic Membranous Nephropathy,” J Am Soc Nephrol, 2012, 23(10):1617-30. [PubMed 22859855]
  129. Wang J, Wiley JM, Luddy R, et al, “Chronic Immune Thrombocytopenic Purpura in Children: Assessment of Rituximab Treatment,” J Pediatr, 2005, 146(2):217-21. [PubMed 15689912]
  130. Wolff D, Schleuning M, von Harsdorf S, et al. Consensus Conference on Clinical Practice in Chronic GVHD: second-line treatment of chronic graft-versus-host disease. Biol Blood Marrow Transplant. 2011;17(1):1-17. [PubMed 20685255]
  131. Wong ET, Tishler R, Barron L, et al. Immunochemotherapy with rituximab and temozolomide for central nervous system lymphomas. Cancer. 2004;101(1):139-145. [PubMed 15221999]
  132. Zaja F, Vianelli N, Volpetti S, et al, "Low-Dose Rituximab in Adult Patients With Primary Immune Thrombocytopenia," Eur J Haematol, 2010, 85(4):329-34. [PubMed 20546023]
  133. Zurawska U, Hicks LK, Woo G, et al, “Hepatitis B Virus Screening Before Chemotherapy for Lymphoma: A Cost-Effectiveness Analysis,” J Clin Oncol, 2012, 30(26):3167-73. [PubMed 22711851]
  134. Zecca M, Nobili B, Ramenghi U, et al, “Rituximab in the Treatment of Refractory Autoimmune Hemolytic Anemia in Children,” Blood, 2003, 101(10): 3857-61. [PubMed 12531800]
Topic 9616 Version 179.0