Rituximab Chapter 27

shevyatiwari's version from 2015-10-26 10:19


Question Answer
Depletes only abnormal CD20_ B cellsF. Also deletes normal
Fully humanF. Chimeric. Manufactured in chinese hamster ovary cells - as is etanercept
Half life of 7 daysF. 21 days
Clearance due to hepatic metabolismF. Due to phagocytosis
Infusion reactions occur in 17% of patientsT. Most mild and with first infusion
Anti drug antibodies between 1-30%T. <1% in lymphoma pts and up to 30% in SLE pts. NOT assoc with adverse effects or symptoms but unknown if they affect levels or B -cell depletion
Binds to surface CD20 T
Enhances B cellsF. Depletes CD 20+ normal and malignant B cells
Category BF. C = for cancer
Hypersensitivity to murine proteins is a C/IT as Chimeric monoclonal antibody . 25% mouse, 75% human
Hypotension, bronchospasm, and angioedema are relative C/IT
Excreted in breast milkT
Tumour lysis syndrome occurs within 24 hoursT. Worst in those with high tumour burdens. Seen in 0.05% - in those unable to clear dying tumour cells. Characterised by a rapid decline in renal function
Interacts with cisplatinT. Increased renal toxicity
Increase in infections for 3 months afterF. 12 months
Haemotopoeitic and plasma cells also decline in numberF, don't express CD20 so are spared
Depletion of B cells is sustained for 6 monthsT. B cell depletion seen within 2-3 weeks and sustained for 6 months . Return to normal within the first year of treatment. Overall - immunoglobulin levels DO NOT DECLINE due to maintenance of plasma cells
B cells don't ever return to normalF, return to normal within first year of treatment
Autoreactive antibodies are primarily produced by CD20 positive cells in the peripheral compartmentsT
Decreased co stimulatory molecules on CD4+ T cells, decreased memory T cells, decreased Treg cells are seen with rituximabF. Decreased co-stumulatory molecules on CD4+ cells , decreased memory T - cells, INCREASED T regulatory cells
Live vaccines should be administered 10 days before rituximabF, 4 weeks