Nurses can administer rituximab safely by rapid infusion

LAS VEGAS—Nurses can safely administer rituximab (Rituxan) to patients with non-Hodgkin's lymphoma in half the usual infusion time, providing substantial benefits to the patients and infusion center alike, researchers reported at the 32nd Annual Congress of the Oncology Nursing Society (abstract 2010). Peggy R. Corey, RN, BSN, OCN, and her nurse and physician colleagues identified several reports describing administration of rituximab over 90 minutes and decided to study whether that approach would be feasible and safe in their rural cancer center, the Center for Cancer and Blood Disorders of the Gundersen Lutheran Health System, La Crosse, Wisconsin.

Patients with NHL were eligible for the rapid infusion protocol if they had received rituximab in the previous 4 months according to the product labeling, had never experienced any grade 3-4 infusion-related toxicities, did not have any contraindications to fluid infusion at a rate of 200 mL/hr, and had an absolute lymphocyte count of less than 10 109/L. They were premedicated with acetaminophen and diphenhydramine, and most also received prednisone.

Patients received rituximab 375 mg/m2 in a total volume of 250 mL of normal saline. On the 90-minute infusion protocol, 20% of the dose was infused in the first 30 minutes (rate, 100 mL/h) and 80% over the next 60 minutes (rate, 200 mL/h).

"We did vitals at the beginning, just before we upped the dose, and again at the end," Ms. Corey said, adding that nurses did not remain with the patients the entire time and that the rapid infusion probably entailed less monitoring overall than a conventional infusion.

The nurses documented any toxicities occurring during and after the infusions. Minor reactions were assessed from phone calls made to the nurses within 24 hours after infusion and by asking patients about symptoms at their next appointment.

A total of 46 patients received 135 rapid infusions of rituximab over a 10-month period, for an average of 3 infusions per patient. The patients ranged in age from 32 to 91 years (mean, 69 years). Half had stage IV disease, and nearly a quarter had stage III disease. They were receiving a variety of rituximab-containing regimens.

Rituximab infusion time was decreased by 50%, and rituximab infused over 90 minutes was safe and well tolerated, "so our protocol now allows for both chemotherapy and rituximab infusions to be completed within 4 hours," Ms. Corey said. There was a single grade 2 adverse event, rigors and back pain in a woman older than age 80 who had not received prednisone as part of her premedication; the symptoms resolved with treatment. "We had no grade 3 or 4 infusion-related events and no increased incidence of minor reactions," she said.

The shorter infusions improved access in the chemotherapy suite, gave patients more flexibility in their treatment scheduling, and allowed patients more time away from the facility thus improving quality of life, Ms. Corey noted. She cautioned that the study was small and the patients were a selected group, so the results may not be generalizable.