Skip Navigation LinksHome > July 2010 - Volume 32 - Issue 5 > Pediatric Dosing of Rituximab Revisited: Serum Concentration...
Journal of Pediatric Hematology/Oncology:
doi: 10.1097/MPH.0b013e3181cf0726
Online Articles: Original Articles

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

Pranzatelli, Michael R. MD* †; Tate, Elizabeth D. C-FNP, MN* †; Verhulst, Steven J. PhD; Bertolone, Salvatore J. MD§; Bhatla, Deepika MD; Granger, Meaghan MD; Lebowizc, Joseph MD; Lockhart, Sharon K. MD**; Wiley, Joseph M. MD††

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Abstract

To longitudinally assess serum concentrations of rituximab, it was administered intravenously to 25 children with opsoclonus-myoclonus syndrome at 375 mg/m2 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 (Cmax) and troughs (Cmin). It then fell precipitously to trace levels at 4 months. However, Cmax and Cmin 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).

© 2010 Lippincott Williams & Wilkins, Inc.

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