Occurrence of TLS, infusion reactions and preventive therapies
(Tables 2, S2 and S3)
The median doses of rituximab were 224 mg (125-570 mg), 224 mg (125-264
mg) and 224 mg (125-574 mg) on days 1, 2 and 3, respectively (Table S2).
Allopurinol, given to the majority of patients (77; 84%), was
administered at a median dose of 300 mg (range: 50-300 mg). Rasburicase
was given to 24 patients (26%) at a median dose of 15 mg (range:
7.5-22.5 mg). A large majority of patients received steroid prophase (n=
77, 82%). Out of the entire cohort, seven patients (7.3%) experienced
TLS. Among them, six cases (6%) were classified as LTLS, while one case
(1%) was a CTLS. This CTLS case defined by stage 3 acute kidney injury
resolved following extensive fluid hydration. Among the LTLS cases,
dialysis was required for one patient with BL due to severe metabolic
alterations. Detailed characteristics of patients experiencing TLS are
presented in Table S3. No significant associations were observed between
TLS incidence and factors such as elevated CCI scores (>8),
elevated International Prognostic Index (IPI) scores (3-5), presence of
bulky disease, use of allopurinol, use of steroid prophase, or the
initial dose of rituximab infusion. However, TLS occurrence was
significantly higher in cases with BL histology compared to those with
DLBCL subtype, in patients with elevated LDH levels exceeding 500 U/L,
in individuals with impaired glomerular filtration rate (GFR) below 45
ml/min, and in patients who received rasburicase (Table 2).
Infusion-related reactions (IRR) to rituximab were reported in three
cases, all of which were classified as mild or moderate.