Stepped Up Dosing

A stepped up dosing schedule, in our experience, minimizes the severity of infusion toxicity to monoclonal antibody therapy. A small dose is given by slow iv infusion the first day, and the dose and infusion rate are then increased in stepwise fashion to target levels. Patients receiving thrice weekly rituximab should receive a 100-mg dose over 4 h (25 mg/h) on the first day of therapy. The second dose should be 375 mg/m2 over 4 h, and subsequent doses can be administered over 1 h each. Patients receiving Campath 1H should receive 3 mg over 2 h on d 1, with escalation of the dose to 10 mg on d 2 and 30 mg on d 3.

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