- Class: Anti-CD20 monoclonal antibody (chimeric IgG1)
- Mechanism: Binds CD20 on B-cells → induces cell lysis via complement-dependent cytotoxicity (CDC) and antibody-dependent cellular cytotoxicity (ADCC)
Indications (Oncology)
- Non-Hodgkin lymphoma (NHL) – CD20+ (e.g., DLBCL, follicular lymphoma)
- Chronic lymphocytic leukemia (CLL)
- Mantle cell lymphoma (often in combo regimens like R-CHOP or R-Bendamustine)
- Others: Autoimmune diseases (e.g., RA, ITP, GPA/MPA) — off-label or FDA-approved for some
Dosing
- IV, typically 375 mg/m² weekly × 4 for lymphomas; varies by indication and protocol
Key Side Effects
- Infusion reactions (fever, chills, hypotension) – especially first dose
- Infections – Hepatitis B reactivation (screen before use), PML (rare but serious)
- Cytopenias (neutropenia, thrombocytopenia)
- Cardiac events (arrhythmia, angina, especially in elderly)
- Tumor lysis syndrome (rare, high-burden disease)
Monitoring
- Before initiation:
- Hepatitis B serology (HBsAg, anti-HBc)
- CBC with differential
- During treatment:
- Infusion reactions (monitor vital signs closely during and after infusion)
- CBC periodically (for cytopenias)
- Signs of infection or TLS
- Cardiac status if high risk
Other Key Points
- Premedicate with acetaminophen + antihistamine ± corticosteroid
- Slow initial infusion rate; may increase gradually if tolerated
- Biosimilars available (e.g., Truxima, Ruxience)
- Often used in combination with chemotherapy (e.g., R-CHOP)