Abstract:

Background: Rituximab is a CD20 targeting monoclonal antibody that is commonly prescribed to manage B-cell lymphoproliferative disorders. Normally, it is used in conjunction with other chemotherapy regimens to treat aggressive and indolent lymphomas. Recently it is utilized as a maintenance therapy single-agent for follicular lymphomas and for other autoimmune diseases. Rituximab is well endured, however, it is found to be associated with a risk of infusion-related reaction. This side effect is more likely to happen with the first dose rather than subsequent doses, though the mechanism is not well understood. The manufacturer recommendation for Rituximab infusion is slow initial rate over 3 to 4 hours, which requires healthcare resources and leads to patient’s dissatisfaction. Research studies have demonstrated that Rituximab can be safely administered using rapid infusion, over 90 minutes, in subsequent infusions as long as the first infusion was well tolerated with no evidence of infusion reaction. Following this converted pharmaceutical protocol resulted in a more efficient utilization of resources and treatment practice. This ultimately will lead to reducing the outpatient clinic visits duration and increase patient satisfaction. Aim: The Study’s primary objective is to reduce the “Infusion time for CD20 positive lymphoma patients who are receiving Rituximab at JHAH oncology institute by at least 40% in 3-5 months period, considering safety of rapid infusion. Methods: A total of 20 patients diagnosed with CD20 positive Lymphoma who were planned to receive Rituximab were included in the study. The action plan was to start Rituximab infusion over 90 minutes from the second treatment cycle, the first cycle infusion time are kept as per the standard practice. When the initial infusion is tolerated well, a 20% of the tolerated dose was administered over 30 minutes, and the remaining 80% was given over 60 minutes, and the same rate will be used for the later doses. Results: Post action plan data analysis indicated that patient infusion times were reduced by 50% from 185 to 93 minutes. In addition to increasing patient satisfaction rate from 78% to 85% during the study period. Conclusion: Rapid Rituximab infusion rate is safe with 0% of reaction. Compared to 10% of historical data and accountable for the sufficient use of oncology clinic, in addition to improving the efficiency that consequently increased patient fulfilment.