Document Detail

Fatal interstitial lung disease induced by rituximab-containing chemotherapy, treatment with TNF-α antagonist and cytokine profiling: a case-report and review of the literature.
MedLine Citation:
PMID:  23506410     Owner:  NLM     Status:  MEDLINE    
WHAT IS KNOWN AND OBJECTIVE: Rituximab, an anti-CD20 monoclonal antibody, is widely used with good response for the treatment of B-cell lymphoma and various refractory autoimmune diseases. Although rituximab is effective, rare but serious pulmonary adverse reactions have been reported. We report on a case of rituximab-induced life-threatening interstitial lung disease in a patient with diffuse large B-cell lymphoma (DLBCL), and describe the patient's serum cytokine profile during anti-TNF-α treatment.
CASE SUMMARY: A 71-year-old woman diagnosed with DLBCL was treated with three cycles of rituximab-containing chemotherapy. She developed a fatal respiratory failure, which was eventually diagnosed as rituximab-induced interstitial lung disease (R-ILD). The R-ILD in this patient did not respond to intensive steroid treatment, or to enternacept, an anti-TNF therapy. During therapy, we observed that the serum level of IL-6 was much higher at the beginning of treatment than was usual for other DLBCL patients. Levels of IL-6 and TNF-α also increased during the course of the clinical exacerbation. We undertook a literature search and reviewed similar cases of R-ILD.
WHAT IS NEW AND CONCLUSION: Although rituximab is generally effective and safe, caution is required for high-risk patients, as in our case, and as reported in several other cases in the literature. Cytokine analysis may help in identifying patients at high risk of R-ILD. Better intensive therapeutic approaches other than steroids are required even during the early stages of the complication.
Yongkang Wu; Yongqian Jia; Juan Xu; Xiao Shuai; Yu Wu
Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't     Date:  2013-03-18
Journal Detail:
Title:  Journal of clinical pharmacy and therapeutics     Volume:  38     ISSN:  1365-2710     ISO Abbreviation:  J Clin Pharm Ther     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-04-22     Completed Date:  2014-02-27     Revised Date:  2014-07-31    
Medline Journal Info:
Nlm Unique ID:  8704308     Medline TA:  J Clin Pharm Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  249-53     Citation Subset:  IM    
Copyright Information:
© 2013 Blackwell Publishing Ltd.
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MeSH Terms
Antibodies, Monoclonal, Murine-Derived / adverse effects*,  therapeutic use
Antineoplastic Agents / adverse effects,  therapeutic use
Cytokines / metabolism
Fatal Outcome
Lung Diseases, Interstitial / chemically induced*,  drug therapy*,  metabolism
Lymphoma, Large B-Cell, Diffuse / drug therapy
Tumor Necrosis Factor-alpha / antagonists & inhibitors*
Reg. No./Substance:
0/Antibodies, Monoclonal, Murine-Derived; 0/Antineoplastic Agents; 0/Cytokines; 0/Tumor Necrosis Factor-alpha; 0/rituximab

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