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Infusion reactions associated with rituximab treatment for childhood-onset complicated nephrotic syndrome

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Abstract

Background

Infusion reaction (IR) is defined as an adverse event within 24 h after monoclonal antibody infusion. In non-Hodgkin lymphoma, IR incidence following rituximab treatment is high (77–80%), but there are no data in complicated nephrotic syndrome.

Methods

Records of rituximab infusions in patients with complicated nephrotic syndrome between February 2006 and December 2014 at the National Center for Child Health and Development were reviewed. Rituximab was administered at doses of 375 mg/m2. The severity of IR was evaluated using the Common Terminology Criteria for Adverse Events ver. 4.0.

Results

For 309 rituximab infusions in 159 patients (male, 110; median age, 12 years), IR was observed in 165 infusions (53.4%). Respiratory symptoms were most common (66% of all events). Ninety-five percent of the IR was observed within 3 h after rituximab infusion initiation. Sixty-eight percent of the events were classified as grade 1 and others classified as grade 2. Only 18% required medical intervention. CD20 cell count in patients with IR was significantly higher than in patients without IR. Incidence of IR was similar in subsequent rituximab treatment after B-cell recovery. Patients who experienced IR at first rituximab treatment were more likely to experience recurrent IR with subsequent treatments compared to those not having IR at initial treatment (odds ratio 3.64; p < 0.001).

Conclusions

In patients with complicated nephrotic syndrome, respiratory symptoms were the major type of IR, mostly observed within 3 h of infusion. Incidence of IR was lower and its severity milder in patients with complicated nephrotic syndrome than those with lymphoma.

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Authors and Affiliations

  1. Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan

    Koichi Kamei, Masao Ogura, Mai Sato & Kenji Ishikura

  2. Department of Pediatrics, Yokohama City University Graduate School pf Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan

    Shuichi Ito

Authors
  1. Koichi Kamei
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  2. Masao Ogura
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  3. Mai Sato
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  4. Shuichi Ito
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  5. Kenji Ishikura
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Correspondence to Koichi Kamei.

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Conflict of interest

KK has received lecture fees from the Chugai Pharmaceutical Co., Ltd. SI has received lecture fees and/or grants from the Chugai Pharmaceutical Co., Ltd.; Zenyaku Kogyo Co., Ltd.; Asahi Kasei Pharma; Novartis Pharma K.K.; and Astellas Pharma Inc. KI has received lecture fees from the Asahi Kasei Pharma; Chugai Pharmaceutical Co., Ltd.; Zenyaku Kogyo Co., Ltd.; and Novartis Pharma K.K. and a consultant fee from Ono Pharmaceutical Co., Ltd.

Ethical approval

The design and execution of this study were in accordance with the ethical standards of the Declaration of Helsinki. The protocol was approved by the Ethics Committee of the National Center for Child Health and Development (no. 1505).

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For this type of study, formal informed consent is not required.

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Kamei, K., Ogura, M., Sato, M. et al. Infusion reactions associated with rituximab treatment for childhood-onset complicated nephrotic syndrome. Pediatr Nephrol 33, 1013–1018 (2018). https://doi.org/10.1007/s00467-018-3900-z

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  • DOI: https://doi.org/10.1007/s00467-018-3900-z

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