Blood Journal
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The role of sex and weight on rituximab clearance and serum elimination half-life in elderly patients with DLBCL

  1. Carsten Müller1,*,
  2. Niels Murawski2,*,
  3. Martin H. J. Wiesen1,
  4. Gerhard Held2,
  5. Viola Poeschel2,
  6. Samira Zeynalova3,
  7. Michael Wenger4,
  8. Christina Nickenig5,
  9. Norma Peter6,
  10. Eva Lengfelder7,
  11. Bernd Metzner8,
  12. Tanja Rixecker2,
  13. Carsten Zwick2,
  14. Michael Pfreundschuh2, and
  15. Marcel Reiser9
  1. 1Institut für Pharmakologie der Uniklinik, Köln, Germany;
  2. 2Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg, Germany;
  3. 3Institut für Medizinische Informatik, Statistik und Epidemiologie, Universität Leipzig, Leipzig, Germany;
  4. 4F. Hoffmann-La Roche Ltd, Basel, Switzerland;
  5. 5Med Klinik und Poliklinik III, Klinikum der Universität, München, Germany;
  6. 6I Med Klinik Hämatologie/Onkologie, Carl-Thiem Klinikum, Cottbus, Germany;
  7. 7III Med Klinik der Universität, Mannheim, Germany;
  8. 8Klinik für Onkologie und Hämatologie, Oldenburg, Germany; and
  9. 9Klinik I für Innere Medizin Uniklinik, Köln, Germany


Pharmacokinetics of 8 doses of rituximab (375 mg/m2) given in combination with 2-week cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone/prednisolone (CHOP-14) was determined by ELISA in 20 elderly patients with diffuse large B-cell lymphoma (DLBCL) 10 minutes before and after each infusion and 1 week and 1, 2, 3, 6, and 9 months after the last infusion. Population pharmacokinetic modeling was performed with nonlinear mixed-effect modeling software (NONMEM VI). Concentration-time data were fitted into an open 2-compartment model and total clearance, central compartment volume, intercompartment clearance, and volume of distribution at steady-state (Vdss) were investigated. Total clearance was 9.43 mL/h and Vdss was 9.61 l. Rituximab clearance was reduced (8.21 mL/h vs 12.68 mL/h; P = .003) and elimination half-life was prolonged in women compared with men (t1/2β = 30.7 vs 24.7 days; P = .003). Body weight also affected Vdss (0.1 l increase of Vdss per kilogram above median of 75 kg). A sex-dependent effect and the higher weight of males contribute to their faster rituximab clearance, which might explain why elderly males benefit less from the addition of rituximab to CHOP than females. This trial was registered on as numbers NCT00052936, EU-20243 (RICOVER-60 Trial), EU-20534, and NCT00726700 (Pegfilgrastim Trial).

  • Submitted September 20, 2011.
  • Accepted January 22, 2012.
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