International Journal of Clinical Pharmacy

, Volume 35, Issue 4, pp 513–519 | Cite as

Pharmaceutical follow-up for patients on rituximab therapy for non-Hodgkin lymphoma: what is the evidence?

  • Vanessa HegeleEmail author
  • Paula Stoll
  • Diego Wüst
  • Guilherme Ehrenbrink
  • Luiza Raquel Grazziotin
  • Juliana Prohonoski Caregnato
  • Luciane Pereira Lindenmeyer
Review Article


Background Introduction of the monoclonal antibody rituximab to chemotherapy regimens has substantially improved disease-free and overall survival in patients with non-Hodgkin lymphomas (NHL). The short-term safety of this drug has been widely reported, but there are few data on long-term safety, which suggests that these patients require prolonged follow-up. Aim of the review To review the literature on follow-up models, with a focus on the safety of rituximab therapy for diffuse large B-cell lymphoma and follicular lymphoma. Method The Cochrane Library, Embassy, Lilacs, Medline, and Scirus databases were searched for systematic reviews and randomized controlled trials. Furthermore, textbooks and journals on pharmaceutical care and institutional websites were searched for patient management recommendations. The outcomes were follow-up models and grade 3, 4, and 5 adverse reactions. Results Five systematic reviews and eight clinical trials or updates describing patient follow-up or reporting adverse reactions were identified. Only one systematic review and seven clinical trials reported follow-up routines for patients receiving rituximab, including information on staging, frequency of reassessment, and laboratory tests, as well as pre-infusion care and management of acute or delayed adverse reactions. Five systematic reviews and four clinical trials reported data on statistically significant adverse reactions (fever, leukopenia, infection). Four guidelines or institutional protocols for treatment and follow-up were identified, as well as seven studies describing experiences in the implementation of pharmaceutical care for oncology patients, but none were specifically focused on follow-up of patients receiving rituximab for NHL. Conclusion Although some systematic reviews and clinical trials contain guidance on follow-up of patients receiving rituximab for NHL, there are no validated strategies for systematic follow-up of these patients with a focus on safety. As there are few data on long-term safety profile of these novel treatments, monitoring strategies should be developed and implemented to ensure safe and optimized use of drugs recently added to the therapeutic arsenal of clinical oncology.


Adverse drug reaction Drug-related problem Hematology Non-Hodgkin’s lymphoma Oncology Pharmaceutical care Pharmacovigilance Rituximab 



To the care team oncology and hematology at the Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Ministry of Health, Brazil.


Brazilian National Health Surveillance Agency (Anvisa).

Conflicts of interest



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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Vanessa Hegele
    • 1
    Email author
  • Paula Stoll
    • 1
  • Diego Wüst
    • 1
  • Guilherme Ehrenbrink
    • 1
  • Luiza Raquel Grazziotin
    • 1
  • Juliana Prohonoski Caregnato
    • 1
  • Luciane Pereira Lindenmeyer
    • 1
  1. 1.Grupo Hospitalar ConceiçãoPorto AlegreBrazil

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