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  • R-chop

    I'm looking for more information on R-CHOP and breastfeeding. Pregnant patient has Diffuse Large B Cell Lymphoma and will have 1-2 rounds of R-CHOP left after delivery. According to Hale (2019), it is recommended that she withhold breastfeeding for 35 days after treatment with Vincristine. However, I'm finding conflicting recommendations for Rituximab. The manufacturer recommends not breastfeeding for 6 months after the last dose. Other information says that due to it's high molecular weight, it may be OK to breastfeed.
    Any additional information/advice is appreciated.

  • #2

    Rituximab is rated an L3-no data-probably compatible. The manufacturer does recommend waiting 6 months after stopping the medication, but Dr Hale thinks it will largely be destroyed in the infants gut prior to absorption. Since the mother needs to wait 35 days to nurse after receiving the vincristine, over half of the rituximab will be out of her system at that time as the half-life is 22 days. "There are no reported levels in human milk, but due to its large molecular weight, it is unlikely to enter milk in clinically relevant amounts. In addition, the low oral bioavailability of this protein suggests little absorption in the infant's gut. Some caution is recommended, especially in the colostral phase, and each woman should understand the benefits and risk of using this type of medication in lactation." (Medications and Mothers' Milk database, Dr Thomas Hale PhD). LactMed also suggest it is not a reason to discontinue breastfeeding, but use with caution in a newborn or premature infant. Monitor the infant for fever, frequent infections, poor feeding/poor weight gain.

    Sandra Lovato R.N.
    InfantRisk Center