Contributions
Abstract: PB2035
Type: Publication Only
Background
The PRIMA study findings support the benefit of 2-years of Rituximab maintenance in patients with follicular lymphoma (FL) responding to immuno-chemotherapy treatment, with maintenance Rituximab delivering a sustained and persistent benefit with improved progression free survival without an unacceptable increase in long term toxicity. Therefore it is now routine practice to offer 2 years of maintenance Rituximab to this group of patients.
Aims
We reviewed our experience of rituximab maintenance in a district general hospital looking particularly at rate of infections and development of complications and toxicities.
Methods
Between January 2011 and January 2018 52 patients completed 2 years of Rituximab maintenance for Follicular lymphoma. We conducted a retrospective case note review, accessing clinical notes, laboratory results and radiological imaging to review for development of immunodeficiency, infection rates, and respiratory complications.
Results
The primary immuno-chemotherapy most frequently used prior to commencing maintenance was R-CHOP (42.3%). Maintenance Rituximab was planned for 24 months.
Infective complications were common with patients receiving on average 2 courses of antibiotics during the maintenance period. Admissions were relatively frequent with 59.6% of patients requiring at least one admission, and 9.6% requiring three of more admissions, with infection being the most common reason for admission. During the maintenance Rituximab period 30.8% of the patients developed neutropenia and 28.8% developed significant hypogammaglobulinemia. 50% reported chest symptoms and 30.8% had new radiological findings of lung disease on CT compared with their end of treatment CT chest before commencing the Rituximab maintenance. Most common changes were atelectasis, but 11.5% developed new ground glass opacities or interlobular thickening, and 2% developed new diagnosis of bronchiectasis. One patient reactivated pulmonary tuberculosis. 3.8% of patients needed to discontinue treatment due to the frequency of respiratory tract symptoms.
Conclusion
This experience from treating patients at a district general hospital highlights that as maintenance Rituximab is increasing being offered due to it’s beneficial affect on progression free survival, we need to be vigilant to the infective and respiratory complications that can develop. Therefore it is imperative that in order to reduce these complications and not adversely impact on the patients quality of life steps should be taken to monitor carefully for development of neutropenia, hypogammoglobulinemia, or chest symptoms or signs in order to take early interventions such as administration of G-CSF or monthly IVIg, and consideration of early imaging to prevent infectious and respiratory complications.
Session topic: 20. Indolent Non-Hodgkin lymphoma – Clinical
Keyword(s): Follicular lymphoma, Maintenance
Abstract: PB2035
Type: Publication Only
Background
The PRIMA study findings support the benefit of 2-years of Rituximab maintenance in patients with follicular lymphoma (FL) responding to immuno-chemotherapy treatment, with maintenance Rituximab delivering a sustained and persistent benefit with improved progression free survival without an unacceptable increase in long term toxicity. Therefore it is now routine practice to offer 2 years of maintenance Rituximab to this group of patients.
Aims
We reviewed our experience of rituximab maintenance in a district general hospital looking particularly at rate of infections and development of complications and toxicities.
Methods
Between January 2011 and January 2018 52 patients completed 2 years of Rituximab maintenance for Follicular lymphoma. We conducted a retrospective case note review, accessing clinical notes, laboratory results and radiological imaging to review for development of immunodeficiency, infection rates, and respiratory complications.
Results
The primary immuno-chemotherapy most frequently used prior to commencing maintenance was R-CHOP (42.3%). Maintenance Rituximab was planned for 24 months.
Infective complications were common with patients receiving on average 2 courses of antibiotics during the maintenance period. Admissions were relatively frequent with 59.6% of patients requiring at least one admission, and 9.6% requiring three of more admissions, with infection being the most common reason for admission. During the maintenance Rituximab period 30.8% of the patients developed neutropenia and 28.8% developed significant hypogammaglobulinemia. 50% reported chest symptoms and 30.8% had new radiological findings of lung disease on CT compared with their end of treatment CT chest before commencing the Rituximab maintenance. Most common changes were atelectasis, but 11.5% developed new ground glass opacities or interlobular thickening, and 2% developed new diagnosis of bronchiectasis. One patient reactivated pulmonary tuberculosis. 3.8% of patients needed to discontinue treatment due to the frequency of respiratory tract symptoms.
Conclusion
This experience from treating patients at a district general hospital highlights that as maintenance Rituximab is increasing being offered due to it’s beneficial affect on progression free survival, we need to be vigilant to the infective and respiratory complications that can develop. Therefore it is imperative that in order to reduce these complications and not adversely impact on the patients quality of life steps should be taken to monitor carefully for development of neutropenia, hypogammoglobulinemia, or chest symptoms or signs in order to take early interventions such as administration of G-CSF or monthly IVIg, and consideration of early imaging to prevent infectious and respiratory complications.
Session topic: 20. Indolent Non-Hodgkin lymphoma – Clinical
Keyword(s): Follicular lymphoma, Maintenance