Medical Oncologist
Rituximab monitoring
Tests and Monitoring — While You Are on Rituximab
Rituximab changes how your immune system works, and that means your blood counts, liver health, and infection defences all need watching throughout treatment. Knowing which tests happen and when helps you understand what your team is looking for.
Medically reviewed by Dr. C. Raghavendra Reddy, Medical Oncologist, MBBS (Gold Medal) · DNB · DM (Medical Oncology, Gold Medal) · Last reviewed August 2026
- Blood counts checked regularly — Rituximab reduces your white blood cells, including the ones that fight infection.
- Hepatitis B screened before you start — Rituximab can reactivate a hepatitis B infection that has been dormant for years.
- Immunity checked over time — Your antibody levels drop during treatment and may take months to recover after it ends.
- Response scans at set points — Imaging shows whether the treatment is working and guides every decision about continuing.
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While on rituximab, your team will monitor your blood counts before each cycle, screen for hepatitis B before treatment starts, and check your immunoglobulin levels and liver function periodically. Response assessment scans are usually done mid-treatment and at the end. NCCN and ESMO guidance requires hepatitis B screening in all patients before the first dose.
Why does rituximab need regular blood tests?
Rituximab works by targeting B-cells, a type of white blood cell central to your immune defence. As B-cells are depleted, your blood counts shift and your ability to fight certain infections drops — so monitoring is not optional, it is how your team keeps the treatment safe.
Most problems that arise during rituximab treatment are manageable when they are found early. The tests are there to catch changes before they become serious, not to look for problems after symptoms appear.
Monitoring is also how your team confirms the treatment is working. Response scans at fixed points in the schedule show whether the disease is responding, and that information shapes every decision about what comes next.
What happens at each stage of monitoring?
Before your first dose
Your team screens you for hepatitis B, takes a baseline blood count, and tests your liver function. This tells them what is normal for you and catches any risk — such as a dormant hepatitis B infection — that would change how rituximab is given.
Before each treatment cycle
A full blood count is done before every infusion, usually within a few days of your scheduled appointment. If your neutrophils or platelets have not recovered sufficiently, your next dose may be delayed until they have.
During each infusion
Your blood pressure, pulse, and temperature are checked at regular intervals throughout the infusion. Rituximab can cause infusion reactions, especially with the first dose, and the nursing team monitors for these from the moment the drip starts.
Mid-treatment scan
After several cycles your team will arrange a CT or PET-CT scan to assess how the disease is responding. This scan guides the plan for the second half of your treatment and is coordinated through CION's partner imaging centres.
End-of-treatment assessment
A final response scan confirms whether remission has been achieved. This result determines whether further treatment is needed and sets the starting point for your follow-up monitoring plan.
After treatment ends
Blood counts and immunoglobulin levels are checked at follow-up appointments for months after your last dose. B-cell depletion and reduced antibody levels can persist long after the infusions stop, so monitoring continues even when treatment is over.
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Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
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Dr. Mohammed Imran
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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Tell your team about any of these at every visit
- Any fever, chills, or signs of infection since your last appointment
- Unusual tiredness or breathlessness that has recently worsened
- Yellowing of your skin or the whites of your eyes
- New headaches, confusion, or changes in your vision
- Any herbal, Ayurvedic, or over-the-counter medicines you are taking
- Whether you have ever been told you had hepatitis B or hepatitis C
- Any planned dental work or surgical procedure coming up
Which test checks what — and what a change means
| Test | When it is done | What a change may mean |
|---|---|---|
| Complete blood count (CBC) | Before each cycle; at follow-up visits after treatment ends | A low neutrophil count raises your infection risk. Your team may delay the next dose, prescribe preventive antibiotics, or add a growth factor injection. |
| Hepatitis B serology (surface antigen and core antibody) | Once before treatment starts; liver enzymes monitored during treatment if positive | A positive result does not stop treatment. Preventive antiviral tablets are started first. Any sign of reactivation during treatment is managed urgently. |
| Liver function tests | Before starting; periodically during treatment | Rising liver enzymes can signal hepatitis B reactivation or liver inflammation. The cause is investigated before treatment continues. |
| Immunoglobulin levels (IgG) | Periodically during treatment and at follow-up visits | Low levels mean your infection-fighting antibodies have dropped significantly. Protective immunoglobulin infusions may be given to reduce your risk of serious infection. |
| Response assessment scan (CT or PET-CT) | Mid-treatment and at the end of treatment | Good response means treatment is on track. A poor or partial response may lead to a regimen change. Scans are coordinated through CION's partner imaging centres. |
Did you know?
Hepatitis B reactivation during rituximab treatment can be severe and occasionally fatal — but it is entirely preventable.
ASCO and NCCN guidance requires hepatitis B screening for every patient before their first dose. Patients who test positive are given preventive antiviral therapy, which substantially reduces reactivation risk.
Source: ASCO Clinical Practice Guideline: Screening for Hepatitis B Virus in Patients Receiving Cytotoxic Chemotherapy; NCCN Clinical Practice Guidelines in Oncology — B-cell Lymphomas
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Common questions
Frequently asked questions
How long does monitoring continue after rituximab finishes?
Monitoring continues for months to years after your last dose. B-cells can remain depleted for six months or longer, and immunoglobulin levels may take even longer to recover. The exact follow-up schedule depends on what you were treated for and how you responded. Your oncologist will set this out at your end-of-treatment visit, but expect blood tests and clinic appointments to continue for at least two years.
What happens if my blood count is too low to have my next dose?
Your next infusion will be delayed, not cancelled. Your team will recheck your count after a short interval and reschedule when it is at a level they consider safe. A dose delay does not mean the treatment has failed — protecting you from infection during the recovery window is the priority. If delays become frequent, your team will review the overall plan.
I had hepatitis B years ago. Can I still have rituximab?
A past hepatitis B infection does not automatically exclude you. Your team will check whether the virus is active or dormant. If markers of past infection are present, you will usually be started on preventive antiviral tablets before rituximab begins and continue them for several months after treatment ends. This approach, recommended by both ASCO and NCCN, substantially reduces the risk of reactivation.
Why is the response scan done in the middle of treatment rather than at the end?
A mid-treatment scan gives your oncologist information while there is still time to act on it. If the disease is responding well, treatment continues as planned. If it is responding poorly, the regimen can be adjusted before more cycles are given on an approach that may not be working. Waiting until the last cycle to assess response would remove that option.
Will my immune system recover after rituximab ends?
For most people, yes — but recovery takes time. B-cells begin to return over several months, and antibody levels usually follow. How quickly this happens varies between patients and depends on how many cycles were given. During the recovery period your infection risk remains higher than usual, which is why follow-up blood tests continue well after the infusions stop. Your team will tell you when your counts suggest your immune defence has returned to a safer level.