(193) Rapid Rituximab Protocol Evaluation and Expansion

Poster Abstract:

Background:
In 2017, a PGY-2 resident quality improvement project evaluated the pre- and post-implementation of rapid rituximab infusion in patients with an oncologic diagnosis. The project found no incidence of infusion reactions with rituximab in the 16 patients that were analyzed; only two patients who received rapid rituximab infusion for the first time had received one prior dose of rituximab. The current eligibility criteria for 90-minute rituximab infusion at St. Luke’s Cancer Institute includes the treatment of an oncologic disorder, non-initial rituximab treatment, last dose of rituximab within 6 months, 18 years of age or older, rituximab dose less or equal to 375mg/m2 or total dose less or equal to 1000mg, circulating lymphocyte count less than 5000cells/mm3, no history of severe infusion reaction with rituximab (≥Grade 3, per CTCAE version 5.0), Eastern Cooperative Oncology Group (ECOG) performance status of 0-2, no significant cardiovascular disease, and patient not pregnant or lactating.

Objectives:
To evaluate the current use of 90-minute rituximab infusion, the appropriateness of protocol eligibility criteria, and assessment for criteria expansion to include other indications and higher rituximab doses.

Methods:
This retrospective, single-center, quality improvement project, included patients age 18 years or older, who received a rapid rituximab infusion from November 1, 2022, to November 1, 2023.
Patients were excluded if rituximab dosing frequency was longer than six months or if the drug was administered inpatient. Data collected included patient’s demographics and baseline characteristics (i.e., age, gender, diagnosis), rituximab indication, number of doses of rituximab received prior to rapid infusion, number of rapid rituximab doses received, the dose of rituximab given as a rapid infusion, pre-medications given, patient eligibility criteria for rapid rituximab infusion, and if the protocol was initiated by a pharmacist, grade of infusion reaction, and drugs used for the management of the infusion reaction if it occurred.

Results, discussion, and conclusions are to be presented at the 2024 Annual HOPA meeting.

References (must also be included in final poster): • Rituxan [Package Insert] South San Francisco: Genentech USA, Inc, 2021.
• Moore DC, Gebru T, Plesca D. Evaluation of a pharmacist-driven rapid infusion rituximab conversion protocol at a multisite cancer center. J Oncol Pharm Pract. 2021 Dec;27(8):1914-1918.
• Ursu SG, Rinchuse DL, Lister J. Rapid rituximab infusion is safe and well tolerated in malignant and benign disease. J Oncol Pharm Pract. 2021 Dec;27(8):1919-1922.
• Pritchard CH, Greenwald MW, Kremer JM, Gaylis NB, Rigby W, Zlotnick S, Chung C, Jaber B, Reiss W; RATE-RA Study Group. Safety of infusing rituximab at a more rapid rate in patients with rheumatoid arthritis: results from the RATE-RA study. BMC Musculoskelet Disord. 2014 May 24;15:177.