Pediatric Dosing of Rituximab Revisited: Serum Concentrations in Opsoclonus-myoclonus Syndrome

作者：Pranzatelli Michael R^*; Tate Elizabeth D; Verhulst Steven J; Bertolone Salvatore J; Bhatla Deepika; Granger Meaghan; Lebowizc Joseph; Lockhart Sharon K; Wiley Joseph M

来源：Journal of Pediatric Hematology/Oncology, 2010, 32(5): E167-E172.

DOI：10.1097/MPH.0b013e3181cf0726

• anti-B-cell agent
• dancing eyes
• IgM depletion
• Kinsbourne syndrome
• neuroblastoma
• paraneoplastic syndrome
• rituximab pharmacokinetics

To longitudinally assess serum concentrations of rituximab, it was administered intravenously to 25 children with opsoclonusmyoclonus syndrome at 375 mg/m(2) on each of 4 consecutive weeks with (Group I and II) or without (Group III) conventional immunotherapy. Serum rituximab levels, drawn before and after each infusion and at later intervals, were analyzed by enzyme- linked immunosorbent assay. Rituximab concentration increased stepwise with each infusion, dropping by the next infusion, thereby forming 4 discrete peaks (C(max)) and troughs (C(min)). It then fell precipitously to trace levels at 4 months. However, C(max) and C(min) curves differed significantly between groups. Compared with the youngest children (Group I), the oldest (Group III) had a 34% lower rituximab concentration at the fourth infusion, 45% less IgM depletion 1 month later, and received 20% less rituximab when the dose was recalculated as mg/kg. Serum IgM and rituximab levels were negatively correlated. Peak rituximab concentration did not correlate with adrenocorticotropic hormone dose. These results indicate that the degree of serum IgM depletion is a useful indicator for rituximab dose equivalency in children of different ages. They also suggest that pediatric rituximab dosing should be based on body weight, not surface area. (ClinicalTrials. gov NCT00244361).

• 出版日期2010-7