Incidence and Predictors of Obinutuzumab Infusion-Related Reactions in Lymphoid Malignancies

A multicenter retrospective study published in Journal of the Advanced Practitioner in Oncology analyzed the incidence, severity, and risk factors for infusion-related reactions (IRRs) associated with obinutuzumab in patients with lymphoid malignancies. The findings highlight the importance of identifying high-risk patients prior to administration and refining management strategies to mitigate IRR severity.

Obinutuzumab, a glycoengineered type II anti-CD20 monoclonal antibody, is associated with a higher rate of IRRs compared to rituximab. This analysis included 113 patients treated between 2015 and 2020 across three institutions, focusing on IRR occurrence during the first infusion.

IRRs occurred in 54% of patients, with most events classified as grade 1 or 2. Grade 3 reactions were seen in 5.3%, and no grade 4 or 5 reactions were reported. The median time to IRR onset was 60 minutes from infusion start.

The study identified several factors associated with higher IRR risk. Baseline lymphocyte count ≥25 × 10⁹/L significantly correlated with IRR occurrence (p = .026). Additionally, patients with chronic lymphocytic leukemia (CLL) experienced IRRs more frequently than those with follicular lymphoma (FL) or other histologies.

“Patients with CLL had the highest incidence of IRRs (79%), whereas patients with FL had a lower incidence (35%),” the authors noted. They also observed that corticosteroid premedication did not significantly reduce IRR incidence, though premedication with acetaminophen and antihistamines was routinely used.

Interestingly, hospitalization status and comorbidities, including history of cardiac or pulmonary disease, did not significantly influence IRR occurrence. Among patients who experienced IRRs, 65% were able to resume and complete the infusion on the same day after interruption and management.

The findings underscore the need for vigilance when administering obinutuzumab, particularly in patients with CLL or elevated baseline lymphocyte counts. “Our study supports the importance of individualized risk assessment prior to obinutuzumab administration,” the authors concluded. “Future prospective studies could help evaluate the effectiveness of adjusted premedication or infusion strategies.”

For oncology clinicians, this study reinforces the utility of pre-infusion lymphocyte count as a potential risk stratification tool. While most IRRs are manageable, identifying patients at elevated risk may improve outcomes and optimize resource use during infusion management.

Source:

McBride A, Stehr H, Andrews C, et al. Obinutuzumab infusion-related reactions: Multicenter retrospective evaluation of incidence, severity, and risk factors. J Adv Pract Oncol. 2024;15(2):176-183.