Patients receiving rituximab induction therapy for CD20-positive B-cell non-Hodgkin Lymphoma (B-NHL) who experience bone marrow infiltration of lymphoma cells should be considered at high-risk for grade 2 or higher infusion-related reactions (IRRs). These findings were published in Advances in Hematology.

For this retrospective study, a team of researchers in Japan enrolled 127 patients with CD20-positive B-NHL who were treated with rituximab at the Kita-Harima Medical Center in Ono, Hyogo, Japan, between 2013 and 2019. 

Patient data was collected from the electronic medical records. IRRs were defined as reactions that emerged within 24 hours of starting rituximab infusion. All enrolled patients had undergone bone marrow aspiration testing or biopsy within 20 days before rituximab induction therapy to determine bone marrow status.

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Patients received intravenous infusion of rituximab 375 mg/m2, plus acetaminophen 400 mg and hydroxyzine 25 mg orally before the infusion. The case description, the highest body temperature within 24 hours of rituximab administration, and responsive treatment and prescription treatment for IRR as detailed in the EMR were used to determine IRR grade. May-Giemsa stain of bone marrow films and flow cytometry examination of bone marrow aspiration samples were used to determine bone marrow infiltration.

Grade 2 or higher IRRs were reported in 43 patients (34% of the total study population), and in 38 patients of a cohort of 96 (40%) who did not receive glucocorticoids before rituximab infusion. Advanced disease and bone marrow infiltration of lymphoma cells were risk factors for IRRs in all patients; however, risk of developing a grade 2 or higher IRR was reduced in patients who received glucocorticoid prior to rituximab infusion, on univariate analysis. 

“[B]one marrow infiltration of lymphoma cells increases the incidental rate of grade 2 or higher IRRs during rituximab induction therapy without glucocorticoid premedication in CD20-positive B-NHL,” the researchers concluded. 

The study was limited by its retrospective nature and small sample size. The researchers also cautioned that there may be some variations in IRR grading, as this was based on each physician’s judgment. 


Ohata S, Takenaka K, Sugiyama D, Sugimoto T. Bone marrow infiltration is a distinctive risk factor for rituximab infusion-related reactions in CD-20-positive B-cell non-Hodgkin lymphoma. Adv Hematol. Published online February 11, 2022. doi:10.1155/2022/3688727

This article originally appeared on Oncology Nurse Advisor