Implication of Rituximab Infusion Reactions on Clinical Outcomes in Patients with Diffuse Large B-Cell Lymphoma: A Single Institution Experience

Abstract Background The addition of the anti-CD20 monoclonal antibody rituximab to chemotherapy for diffuse large B-cell lymphoma (DLBCL) has led to improvements in progression-free survival and overall survival, although the exact mechanism of rituximab is not known. Rituximab administration often results in transient, non-life threatening infusion reactions (IR). We report a retrospective cohort of patients with DLBCL who received rituximab to determine the significance of IRs on clinical outcomes. Patients and Methods We identified and analyzed a retrospective cohort of 229 patients with DLBCL. They were stratified into two cohorts, those who did and did not have an IR. Univariate and multivariate analyses were performed to evaluate the prognostic significance of rituximab-related IRs relative to DLBCL subtype, international prognostic index (IPI) score, c-Myc translocations or amplifications, chemotherapy regimen, and Ki-67 proliferative index. Results Baseline characteristics did not differ significantly between the two groups. Rituximab was included as initial treatment in all patients. Patients with an IR had a significantly higher overall survival (HR 0.26, 95% CI 0.07-0.95) at 5 years. In addition, subgroup analysis showed a significantly higher progression-free survival in patients with the germinal center subtype of disease and c-Myc alterations who had a rituximab-related IR (log-rank p Conclusions The presence of a rituximab-related IR is associated with a better overall survival in patients with DLBCL. While limited by small sample size and retrospective nature, these results provide rationale for further investigation into the mechanism of action of rituximab in order to optimize the efficacy of CD20 monoclonal antibodies.