Effectiveness of fractionated rituximab in preventing tumor lysis syndrome in aggressive B-cell lymphoma : Insights from real-life clinical practice

Article Article scientifique Article Effectiveness of fractionated rituximab in preventing tumor lysis syndrome in aggressive B-cell lymphoma : Insights from real-life clinical practice eng 2024-10 author Mohamad Jasmine Translational Research Centre in Onco-Hematology, Faculty of Medicine, University of Geneva and Swiss Cancer Center Leman, Geneva, Switzerland. 822228 author Bouroumeau Antonin Division of Clinical Pathology, Diagnostic Department, Geneva University Hospital, Geneva, Switzerland. 955005 author Mckee Thomas Alexander 0000-0002-2147-3136 Department of Patho-Immunology, Geneva University Medical Centre, Geneva, Switzerland. 549937 author Mach Nicolas 0000-0001-8944-1088 Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland. 32943 Département de médecine (DEMED) author Samii Kaveh Department of Hematology, Hôpitaux Universitaires de Genève, Geneva, Switzerland. 24652 author Chamuleau Martine Department Hematology, Cancer Center Amsterdam, Amsterdam, Netherlands. author Stenner Frank Department Oncology, University Hospital Basel and SAKK, Basel, Switzerland. author Tamburini Bonnefoy Jérôme 0000-0002-0167-5996 Translational Research Centre in Onco-Hematology, Faculty of Medicine, University of Geneva and Swiss Cancer Center Leman, Geneva, Switzerland.,Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland. 909914 Département de médecine (DEMED) author Lang Noémie 0000-0003-1243-4888 Translational Research Centre in Onco-Hematology, Faculty of Medicine, University of Geneva and Swiss Cancer Center Leman, Geneva, Switzerland.,Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland. 857396 Département de médecine (DEMED) e1983 10.1002/cnr2.1983 39410860 2573-8348 PMC11480531 https://onlinelibrary.wiley.com/doi/10.1002/cnr2.1983 Background: Tumor lysis syndrome (TLS) is a potentially life-threatening condition resulting from the rapid destruction of malignant cells, leading to electrolyte imbalances and severe complications, such as acute kidney injury, arrhythmias, and seizures. TLS can be managed through hyperhydration, urate-lowering treatments, and a steroid prophase strategy. Aims: This study aims to explore the impact of fractionated rituximab, an anti-CD20 antibody, on the occurrence and severity of TLS during the initial cycle in patients with aggressive B-cell non-Hodgkin lymphoma (B-NHL). Methods: Data was retrospectively collected from 94 of 186 patients. Results: Among the 94 patients included in the analysis, the median age was 70. Histologies were diffuse large B-cell lymphoma (75%), Burkitt lymphoma (13%) and high-grade B-cell lymphoma (8%). The majority were at an advanced stage (93%) with a high IPI score (75%). Most patients received anthracycline-containing regimens (72%) and prophylactic allopurinol (83%) and/or rasburicase (26%). Steroid prophase was administered to 82% of patients. The study identified one clinical TLS case and six laboratory TLS cases. Significant TLS factors included BL histology, elevated baseline LDH (⟩500 U/l), and rasburicase usage. Infusion reactions were rare (3%). Median progression-free survival was 2.6 years, and 2-year overall survival was 33%, irrespective of TLS occurrence. Conclusion: In this real-life study, clinical TLS occurrence was low (1%). TLS appeared more frequent in BL but did not impact overall survival. Fractionated initial rituximab dosing in addition to preventive strategies is a feasible approach in preventing clinical TLS, warranting further prospective investigation. Aggressive B lymphoma Rituximab Tumor lysis syndrome Humans Tumor Lysis Syndrome / etiology Tumor Lysis Syndrome / prevention & control Rituximab / administration & dosage Rituximab / adverse effects Rituximab / therapeutic use Male Female Aged Retrospective Studies Middle Aged Aged, 80 and over Adult Antineoplastic Agents, Immunological / adverse effects Antineoplastic Agents, Immunological / therapeutic use Antineoplastic Agents, Immunological / administration & dosage Lymphoma, Large B-Cell, Diffuse / drug therapy Lymphoma, Large B-Cell, Diffuse / pathology Lymphoma, Large B-Cell, Diffuse / mortality Antineoplastic Combined Chemotherapy Protocols / adverse effects Antineoplastic Combined Chemotherapy Protocols / therapeutic use Lymphoma, B-Cell / drug therapy Lymphoma, B-Cell / pathology Lymphoma, B-Cell / mortality Dewey 616.07 Dewey 616 137 Département de pathologie et immunologie 21F 56 Département de médecine 221 false 503 SERVICE DE PATHOLOGIE CLINIQUE 841 1257 Lymphomes et leucémies 994 388 Immunothérapie 654 476 Lymphomes MALT et réplication virale 807 Cancer reports 7 10 533726f3-bd69-488d-b182-efa277c87a71 Article (Published version) Public Article_scientifique_from_europePmc.pdf 1224756 application/pdf CC BY-4.0 31862a442f8ca71dc0025569fc59060bfdec8b47ef21137560282873c0f58c0d 07fc7bf0-4606-476b-9ec7-45878edde47c Appendix Public CNR2-7-e1983-s001.docx 14434 application/vnd.openxmlformats-officedocument.wordprocessingml.document 874565f8def9a27231c3cafb2d36c30685af93c56fbb78999f7e09eda69d1904 aa190536-518e-4909-b992-775cdcfbec1d Appendix Public CNR2-7-e1983-s002.docx 18071 application/vnd.openxmlformats-officedocument.wordprocessingml.document aed3489cbad561148c3e7a1e5be1b1a6df92257dab6504e70d5e61e388a84dc6 d1d38ae8-59a5-4e74-ac7d-e08e4741bc64 Appendix Public CNR2-7-e1983-s003.docx 13914 application/vnd.openxmlformats-officedocument.wordprocessingml.document 0e40f01cad1e739eaf272214afc41e7d7451a09dd59f75bdda9fcbb02bcfb512 openAccess Faculté de médecine / Section de médecine fondamentale / Département de pathologie et immunologie Faculté de médecine / Section de médecine clinique / Département de médecine

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Effectiveness of fractionated rituximab in preventing tumor lysis syndrome in aggressive B-cell lymphoma : Insights from real-life clinical practice	Cancer reports	2024	77	655
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