Evaluating subcutaneous rituximab for patients with non-Hodgkin lymphoma

This study examined whether it is safe to switch from intravenous to subcutaneous rituximab (Rituxan) during first-line treatment of non-Hodgkin's lymphoma (NHL). The authors concluded that subcutaneous rituximab was safe and effective, and improved quality of life for patients.

Rituximab is a standard treatment for NHL, including diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). It works by targeting cancer cells for attack by the body's immune system. While it is usually given intravenously (injected directly into the veins), rituximab can also be given under the skin (subcutaneously).

Intravenous rituximab involves long administration times and requires getting access to a vein. Direct injection is also associated with side effects. All of these issues can be a burden on patients. Subcutaneous rituximab is easier and faster to administer (5 to 6 minutes). However, whether subcutaneous rituximab is as safe and effective as conventional intravenous treatment for patients with NHL is unclear.

This study included 140 patients with NHL. 111 patients had FL and 29 patients had DLBCL. All patients had already received at least one dose of intravenous rituximab. During chemotherapy, patients were switched to subcutaneous rituximab for an average of 6 cycles. After treatment, 84 patients were given rituximab maintenance therapy to delay cancer recurrence (relapse). Patients were followed up every 3 months for 1 year, and then every 6 months for another year.

Among 56 evaluable patients, 69.6% had no signs of cancer after treatment. 67.9% reported being satisfied with subcutaneous rituximab. After treatment, 60.7% of patients highly rated their overall quality of life.

Overall, 95.0% of patients had side effects. The most common side effects were redness at the site of injection (26.4%), low white blood cell count (22.9%), and a loss of energy and/or weakness (22.1%). Overall, 38.6% of patients had serious side effects. Low white blood cell count was the most common (20.7%). 8.6% of patients reported low white blood cell count with fever.

218 injection-related side effects were reported by 48.6% of patients. Most (84.9%) of these side effects were at the injection site. 4 patients (2.1%) reported serious side effects, including redness, pain, and feeling lightheaded. 8 patients with DLBCL and 16 patients with FL stopped treatment due to side effects.

This study concluded that subcutaneous rituximab was as safe and effective as the intravenous drug while improving the quality of life for patients.

This study was funded by Roche, the manufacturer of rituximab. Also, fewer patients with DLBCL were included compared to patients with FL.