International Journal of Hematology and Oncology 2021, Vol 31, Num 4 Page(s): 220-226
Incidence of Non-Neutropenic Infection (NNI) in Patients with Follicular Lymphoma and Small Lymphocytic Lymphoma: The Effects of Rituximab Therapy

Rezwan ISLAM1, Mahbubur RAHMAN2, M. Anwarul Huq MIAN3, Hilmi EGE1, Douglas REDING4, Md Abdus SHAKOOR5, Hong LIANG6, Richard MERCIER4

1Marshfield Clinic, Department of Hematology and Oncology, Weston Center, Weston, Wisconsin, U.S.A
2University of Texas Medical Branch, Department of Obstetrics and Gynecology, Galveston, Texas, U.S.A
3Joseph M. Still Research Foundation at Doctors Hospital, Augusta, Georgia, U.S.A
4Oncology, Marshfield Clinic, Department of Hematology, Marshfield Center, Marshfield, Wisconsin, U.S.A
5Bangabandhu Sheikh Mujib Medical University, Department of Physical Medicine & Rehabilitation, Dhaka, BANGLADESH
6Marshfield Clinic Research Foundation, Department of Biostatistics and Bioinformatics, Marshfield, Wisconsin, U.S.A

Keywords: Rituximab, Follicular lymphoma, Small lymphocytic lymphoma, Incidence, Infection
Rituximab is an anti-CD20 monoclonal antibody that has demonstrated efficacy in patients with indolent and aggressive forms of non-Hodgkin’s lymphoma and has become part of the standard therapy for patients with B-cell malignancies. The study was designed to examine if rituximab increases the risk to develop non-neutropenic infection (NNI). Medical records of 202 patients diagnosed as follicular lymphoma or small lymphocytic lymphoma were reviewed. Negative binomial regression was used to estimate relative risk (RR) of NNI. Rituximab (n= 41) and non-rituximab (n= 161) groups had a total of 31.636 and 195.691 reviewed patient days, and recorded a total of 67 and 154 infections, respectively. Negative binomial regression analysis revealed significant effects for the treatment (rituximab vs. non-rituximab) and age (p< 0.01). The RRs of viral and bacterial NNI for rituximab group compared to nonrituximab group were 3.33 and 2.60, respectively; while the RRs for one year increment of age were 1.03 and 1.04, respectively. The time-to-first viral and bacterial NNI for rituximab group were significantly faster than non-rituximab group. Rituximab may increase the risk of NNI in patients with follicular lymphoma or small lymphocytic lymphoma.