Rituximab
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Lumbosacral paraesthesia following intrathecal administration: 3 case reports Three patients aged 48-58 years [sexes not stated] experienced painful lumbosacral paraesthesia after receiving intrathecal rituximab. The patients received three cycles of rituximab 375 mg/m2 on day 5 of a 28 day cycle [route not stated] as part of a clinical trial to for CNS recurrence of systemic Bcell non-Hodgkin’s lymphoma. This was followed by autologous stem cell transplantation. The patients also received intrathecal rituximab via lumbar puncture; the first injection consisted of 10mg with subsequent dosages increased to 25mg. After the first injection of rituximab 25mg, two patients experienced extremely painful paraesthesia in the feet, legs and buttocks immediately following administration. The sensation lasted 30-60 minutes and blood pressure temporarily increased. The protocol was amended for the third patient; who received a dilution of rituximab in 0.9% saline to 5 mg/mL and additional premedication with antihistamines. However, this patient developed the same symptoms of paraesthesia. The pain resolved completely within a few hours, in all three affected patients. They refused further intrathecal rituximab and instead received methotrexate. Author comment: "We postulate a direct interaction with spinal nervous structures (radices?) as the most likely explanation for this adverse reaction to rituximab." Bromberg JEC, et al. Acute painful lumbosacral paresthesia after intrathecal rituximab. Journal of Neurology 259: 559-561, No. 3, Mar 2012. Available from: 803075909 URL: http://dx.doi.org/10.1007/s00415-011-6190-y - Netherlands
0114-9954/10/1416-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 25 Aug 2012 No. 1416
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