Rituximab is associated with an increased risk of malaria among adult lymphoma patients in Malawi: a prospective observational cohort.
[BACKGROUND] Rituximab has become a standard of care for many B-cell neoplasms, such as diffuse large B-cell lymphoma (DLBCL).
- p-value p = 0.039
- p-value p = 0.011
- 95% CI 1.1-12
APA
Eastburg L, Makhijani SA, et al. (2025). Rituximab is associated with an increased risk of malaria among adult lymphoma patients in Malawi: a prospective observational cohort.. EClinicalMedicine, 90, 103597. https://doi.org/10.1016/j.eclinm.2025.103597
MLA
Eastburg L, et al.. "Rituximab is associated with an increased risk of malaria among adult lymphoma patients in Malawi: a prospective observational cohort.." EClinicalMedicine, vol. 90, 2025, pp. 103597.
PMID
41333895
Abstract
[BACKGROUND] Rituximab has become a standard of care for many B-cell neoplasms, such as diffuse large B-cell lymphoma (DLBCL). However, the impact of rituximab-induced B-cell deficiency on the risk of malaria for patients residing in endemic areas is unknown. Thus, this study evaluated the incidence of and risk factors for malaria among DLBCL participants in Malawi with a specific interest on those treated with rituximab plus chemotherapy vs chemotherapy alone.
[METHODS] We conducted a post hoc analysis of a prospective, observational cohort of 96 participants, aged ≥18 years, with DLBCL treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or rituximab plus CHOP (R-CHOP) from June 2013 to December 2019 (NCT0266710). We defined symptomatic malaria as a positive malaria rapid diagnostic test or blood film performed for clinical diagnosis. We also retrospectively measured histidine-rich protein 2 (HRP2) antigen and malaria-specific antibody levels.
[FINDINGS] Fourteen participants developed symptomatic malaria; 5/59 (8%) had been treated with CHOP and 9/37 (24%) R-CHOP (OR 3.5, 95% CI 1.1-12; p = 0.039). Symptomatic malaria was not associated with age, performance status, or HIV infection. Thirty-two participants had HRP2 antigenemia; 24 (43%) CHOP and 8 (28%) R-CHOP (p = 0.18). Among HRP2-positive cases, antigenemia was significantly higher in R-CHOP participants (3.6 ng/mL vs 0.92 ng/mL; p = 0.011). There were no significant changes in malaria-specific antibody levels between treatment groups.
[INTERPRETATION] This may suggest that rituximab increases the risk of symptomatic malaria in adult DLBCL patients. Further studies are needed to confirm this association and to understand which mediators of protective immunity are impaired and whether antimalarial chemoprophylaxis is warranted in such settings.
[FUNDING] This study was funded by the United States National Institutes of Health (K01TW011470, U54CA254564, U54CA190152, and K24AI134990).
[METHODS] We conducted a post hoc analysis of a prospective, observational cohort of 96 participants, aged ≥18 years, with DLBCL treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or rituximab plus CHOP (R-CHOP) from June 2013 to December 2019 (NCT0266710). We defined symptomatic malaria as a positive malaria rapid diagnostic test or blood film performed for clinical diagnosis. We also retrospectively measured histidine-rich protein 2 (HRP2) antigen and malaria-specific antibody levels.
[FINDINGS] Fourteen participants developed symptomatic malaria; 5/59 (8%) had been treated with CHOP and 9/37 (24%) R-CHOP (OR 3.5, 95% CI 1.1-12; p = 0.039). Symptomatic malaria was not associated with age, performance status, or HIV infection. Thirty-two participants had HRP2 antigenemia; 24 (43%) CHOP and 8 (28%) R-CHOP (p = 0.18). Among HRP2-positive cases, antigenemia was significantly higher in R-CHOP participants (3.6 ng/mL vs 0.92 ng/mL; p = 0.011). There were no significant changes in malaria-specific antibody levels between treatment groups.
[INTERPRETATION] This may suggest that rituximab increases the risk of symptomatic malaria in adult DLBCL patients. Further studies are needed to confirm this association and to understand which mediators of protective immunity are impaired and whether antimalarial chemoprophylaxis is warranted in such settings.
[FUNDING] This study was funded by the United States National Institutes of Health (K01TW011470, U54CA254564, U54CA190152, and K24AI134990).