For inpatient treatment of lymphoma and ALL, can rituximab be delayed?

I.e., Can day 2 Rituximab (RCHOP) or day 6 Rituximab (DA-EPOCH, Hyper CVAD) be given? Or should only Day 1 Rituximab be used with chemoimmunotherapy in lymphoma and ALL? Our hospital prefers outpatient Rituximab due to the cost.

2 Answers

Mednet Member

Medical Oncology · UT Southwestern Medical Center

Answered on

Although I am not aware of published data on this issue, at least for patient receiving DA-R-EPOCH, I have learned that it is common practice to delay the day 1 rituximab because of the reimbursement issue you refer to. I don't think the effect of this has been studies systematically, but i'm not aware of any data to suggest a worse outcome with this approach.

Delaying day 1 rituximab in R-CHOP is also fairly common.

I am not aware if there are equivalent data for HyperCVAD

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Mednet Member

Medical Oncology · Siri Onclogy and hematology Infusion Service

Answered on

I have commonly delayed the rituximab. Some patients have severe reactions on starting the rituximab presumably due to cytokine release by sensitive tumor cells. I then immediately stop and give the therapy at the end of CHOP and find that the reaction does not occur since considerable tumor death has occurred.

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