Aim Rituximab is indicated in many different conditions within the paediatric oncology, haematology, and bone marrow transplant patient population. It is used for a variety of diseases, including CD20 positive leukaemia/lymphoma, chronic graft versus host disease, severe chronic idiopathic thrombocytopenic purpura, Epstein Barr virus and thrombotic thrombocytopenic purpura.

Unfortunately, rituximab administration is often a lengthy process taking more than 4.5 hours for each dose to be given. This leads to extra nursing acuity, a stress on bed availability and sometimes a need to admit patients to start or end therapy on an inpatient ward. An infusion length of averaging 4.5 hours per dose was suggested historically, in part because of the risk of an adverse infusion reaction. Upon reviewing our rituximab protocol, we decided to adapt a new method of administration.¹ The drug was to be given over 90 minutes from the second cycle. Following this change of practice, we performed an audit to ensure this was tolerated.

Method Retrospective analysis of rituximab administration was performed over the prior 12 months using the electronic dispensing system and cross referencing with medical notes and medication charts. The primary goal was to collate the number, and severity, of adverse drug reactions following the change in practice. Patients were given the Rixathon brand of rituximab and were pre-medicated, with paracetamol, chlorphenamine and hydrocortisone, if there was not a steroid already prescribed for a cancer indication as per local standard practice.

Results A total of 4 number of patients were given 14 doses of rituximab at the rapid rate of infusion. There were no minor or serious reactions recorded. On average, 2.5 hours of administration time was saved per patient. This totals 35 hours over the year. This is equivalent to 4.3 bed days on the outpatient chemotherapy unit.

Conclusion Given that administering rituximab over 90 minutes was well tolerated we found this to be a significant improvement for patients, reducing bed pressure and nursing time needed on the unit.

Reference

1. Gaffney KJ, Dahl EM, Stanton MP, Starek E, Zembillas AS. Rapid-infusion rituximab in a pediatric population. J Pediatr Pharmacol Ther 2020;25:215–219. doi:10.5863/1551-6776-25.3.215.