LAUSR

Rituximab (R) (Rituxan®, Roche, Basel Switzerland) is the first antiCD20 monoclonal antibody that has demonstrated efficacy in patients with various lymphoid malignancies, including indolent and aggressive forms of B-cell non-Hodgkin's lymphoma and B-cell chronic lymphocytic leukemia [1]. Administered intravenously (IV), it has been shown to be also efficient to treat other hematologic situations such as EBV reactivation, especially after hematopoietic stem cell transplantation (HSCT), [2] or ITP [3]. Finally, survivals of younger patients with CD20-positive Philadelphia-negative ALL are significantly increased when combining IV-R with chemotherapy [4]. Recently, a subcutaneous (SC) formulation of R (Rituxan HycelaTM, rituximab and hyaluronidase human, Roche, Basel, Switzerland) has been approved by FDA for B-cell lymphoma. SC-R includes the same monoclonal antibody as intravenous rituximab in combination with hyaluronidase human, an enzyme that helps to deliver rituximab under the skin. Clinical studies have demonstrated that subcutaneous administration of SC-R resulted in non-inferior levels of rituximab in the blood and comparable clinical efficacy outcomes compared to IV-R [1]. It provides a highly-concentrated fixed dose of rituximab with the advantages of reducing treatment times and nursing workload [5] and potentially providing greater comfort and convenience for patients [6] and lesser dosing errors, shorter preparation time or reduced drug wastage for pharmacy dispensers. However, patients can currently only receive SC-R after at least one full dose of IV-R and premedication. The most common (≥20%) adverse reactions observed with SC-R are infections, neutropenia, nausea, constipation, cough and fatigue, alopecia, nausea and erythema at the injection site. At our knowledge, there is no published data addressing the tolerance and the efficacy of SC-R given to patients with other indications than CD20+ B cell lymphoma. As a consequence, we have retrospectively analyzed all cases who received at our center (University Hospital of Nantes, France) at least one dose of SC-R but with no lymphoma indication.