Rituximab-induced interstitial lung disease

Am J Hematol. 2007 Oct;82(10):916-9. doi: 10.1002/ajh.20910.


The aim of this study is to characterize rituximab-induced interstitial lung disease (R-ILD). The information on all reported cases of R-ILD was reviewed. This analysis focused on patient characteristics, underlying disease, rituximab dosing schedule, and R-ILD characteristic-like symptoms, diagnosis, treatment, and outcomes. Sixteen cases of R-ILD, including our two cases, have been reported in the literature. Commonalities include older age, clinical presentation, computerized tomography findings, pulmonary function tests, and biopsy findings. Therapy included corticosteroids and broad spectrum antibiotics. Prognosis has been variable. Patients who worsen despite corticosteroids have a poor outcome. The pathogenesis of R-ILD is largely unknown. Potential explanations for R-ILD may include the induction and release of cytotoxic substances. R-ILD is a rare but potentially fatal pulmonary toxicity due to rituximab. R-ILD should be considered in patients who present with dyspnea, fever, and cough, and there is no clear evidence of infection. Prompt diagnosis and treatment with corticosteroids is essential.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal, Murine-Derived
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Cough / etiology
  • Cyclophosphamide / administration & dosage
  • Doxorubicin / administration & dosage
  • Doxorubicin / analogs & derivatives
  • Dyspnea / etiology
  • Fatal Outcome
  • Fever / etiology
  • Humans
  • Lung Diseases, Interstitial / chemically induced*
  • Lung Diseases, Interstitial / drug therapy
  • Lymphoma, Large B-Cell, Diffuse / complications
  • Lymphoma, Large B-Cell, Diffuse / drug therapy
  • Male
  • Middle Aged
  • Prednisone / administration & dosage
  • Prognosis
  • Rituximab
  • Tumor Necrosis Factor-alpha / metabolism
  • Vincristine / administration & dosage


  • Adrenal Cortex Hormones
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Murine-Derived
  • Tumor Necrosis Factor-alpha
  • Rituximab
  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Prednisone

Supplementary concepts

  • CHOP protocol, modified