International Journal of Clinical Pharmacy

, Volume 39, Issue 2, pp 380–385 | Cite as

A clinical prediction model for infusion-related reactions to rituximab in patients with B cell lymphomas

  • Tatsuya Hayama
  • Katsuhiro MiuraEmail author
  • Akihiro Uchiike
  • Masaru Nakagawa
  • Daisuke Tsutsumi
  • Masashi Sakagami
  • Yoshikazu Yoshida
  • Masami Takei
Research Article


Background Infusion-related reactions (IRRs) are a major adverse event of rituximab. Objective To develop a prediction model for IRRs to rituximab among patients with B cell non- Hodgkin’s lymphomas (B-NHL). Setting A 1000-bed university hospital in Tokyo. Methods Patients with B-NHL treated with rituximab at our institution from 2004 to 2014 were retrospectively analysed. Chills, fever, rash, nausea, asthenia, headache, cardiovascular symptoms, and respiratory symptoms of any grade, in association with rituximab infusion, were identified as IRRs. Risk factors for IRRs to rituximab found in the intergroup analysis were subsequently evaluated by using multivariate analysis. Main outcome measure Occurrence of IRRs to rituximab. Results A total of 140 patients with various types of B-NHL, including 74% with diffuse large Bcell lymphoma, were analysed. Among them, 55 and 85 patients were assigned to the IRR group and the non-IRR group, respectively. Indolent histological subtypes, bulky disease (>10 cm), B symptoms, higher serum soluble interleukin-2 receptor concentration, and bone marrow involvement were more common in the IRR group. The multivariate logistic regression analysis identified low-grade lymphomas [odds ratio (OR) 2.81, p = 0.017] and bulky disease (OR 2.52, p = 0.037) as independent risk factors for IRRs to rituximab. The incidence rates of IRRs to rituximab among patients with neither, one, or both of these risk factors were 26, 54, and 78%, respectively (χ2 = 16.4, p < 0.001). Conclusions A simple combination of histopathological subtype and bulkiness of disease could predict the risk of IRRs to rituximab among patients with B-NHL.


B-cell non-Hodgkin’s lymphoma CD20 Infusion-related reactions Rapid infusion Rituximab 



The authors would like to thank to Dr. H. Takahashi, Dr. D. Kurita, Dr. S. Ohtake, Dr. Y. Uchino, Dr. H. Kodaira, Dr. N. Iriyama, Dr. A. Hojo, Dr. Y. Kobayashi, and Professor Y. Hatta for their valuable contribution to this work.

Conflicts of interest

K. Miura and M. Takei received speaker’s fees from Chugai Pharmaceuticals Co. LTD., which manufactures rituximab in Japan. M. Takei also received research grants from Chugai Pharmaceuticals Co. LTD. All remaining authors have declared no conflicts of interest.


This study was not financially supported by any third parties.


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Copyright information

© Springer International Publishing 2017

Authors and Affiliations

  • Tatsuya Hayama
    • 1
    • 2
  • Katsuhiro Miura
    • 2
    • 3
    Email author
  • Akihiro Uchiike
    • 1
    • 2
  • Masaru Nakagawa
    • 3
  • Daisuke Tsutsumi
    • 1
  • Masashi Sakagami
    • 3
  • Yoshikazu Yoshida
    • 1
  • Masami Takei
    • 3
  1. 1.Department of PharmacyNihon University Itabashi HospitalTokyoJapan
  2. 2.Tumor CenterNihon University Itabashi HospitalTokyoJapan
  3. 3.Department of Hematology and RheumatologyNihon University School of MedicineTokyoJapan

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