Medical Oncologist
Before you start
Who Can Have — Rituximab?
Rituximab targets a protein called CD20 on B-cells. If your lymphoma or leukaemia carries that protein, you may be a candidate. CD20 testing on your biopsy tissue is the single result that answers the question.
Medically reviewed by Dr. C. Raghavendra Reddy, Medical Oncologist, MBBS (Gold Medal) · DNB · DM (Medical Oncology, Gold Medal) · Last reviewed August 2026
- CD20 is the deciding test — Your biopsy tissue is checked for a protein called CD20. Without it, rituximab has nothing to attach to.
- B-cell cancers only — Rituximab targets B-lymphocytes. It is not used for T-cell lymphomas, myeloma, or solid tumours.
- Hepatitis B must be checked first — Rituximab can cause hepatitis B to reactivate. Screening is mandatory before you start.
- Given as day care at CION — At CION, rituximab is administered as an infusion in a day-care setting — no overnight stay needed.
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Rituximab is suitable for patients whose B-cell cancer is CD20-positive. CD20 status is confirmed by testing your biopsy tissue. NCCN and ESMO guidance supports its use in CD20-positive diffuse large B-cell lymphoma, follicular lymphoma, and CLL. If your tumour does not express CD20, rituximab is unlikely to help.
Does your cancer type make you eligible for rituximab?
Rituximab works by binding to CD20, a protein on the surface of B-lymphocytes. If your cancer cells carry that protein, rituximab attaches to them and signals your immune system to destroy them.
CD20 is expressed on most B-cell non-Hodgkin lymphomas and on many cases of chronic lymphocytic leukaemia. It is not present on T-cell cancers, plasma cell cancers such as myeloma, or most solid tumours.
The only way to confirm CD20 status is to test the tissue from your biopsy. That test is usually part of your standard diagnostic workup, so the result may already be in your pathology report.
Who is eligible — and who is not?
- Likely eligible: your biopsy confirms CD20-positive cells.This is the single most important result. It is the basis on which rituximab is prescribed.
- Likely eligible: your diagnosis is a B-cell lymphoma.This includes DLBCL, follicular, marginal zone, and mantle cell lymphoma.
- Likely eligible: your diagnosis is B-cell CLL.Rituximab is used in combination with chemotherapy in eligible CLL patients.
- Likely eligible: hepatitis B screening is negative or managed.If HBV is present, antiviral cover must be in place before rituximab starts.
- Not eligible: your tumour is CD20-negative.Rituximab has no mechanism of action without a CD20 target on the cancer cell.
- Not eligible: your diagnosis is a T-cell lymphoma or myeloma.CD20 is not expressed in these cancers. A different treatment targets them.
- Not eligible to start yet: active, unmanaged hepatitis B is present.Treatment must wait until antiviral cover is established and your team is satisfied it is safe to proceed.
Meet the Specialists
17+ senior cancer specialists. One panel for your case.
Trained at AIIMS, Tata Memorial, and leading international centres. Combined 150+ years of experience. Every complex case is reviewed by 3+ of them — together.
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
Surgical Oncologist
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
Interventional Radiologist
Dr. Mohammed Imran
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
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What do the terms on your biopsy report mean?
- CD20
- A protein that sits on the surface of B-lymphocytes. Rituximab locks onto it to mark cancer cells for destruction by your immune system.
- CD20-positive
- The laboratory finding that your cancer cells express enough CD20 for rituximab to work. This result makes you a candidate for rituximab-containing treatment.
- IHC (immunohistochemistry)
- A staining test performed on biopsy tissue that shows which proteins are present on cancer cells. This is how CD20 is typically detected in lymphoma.
- Flow cytometry
- A test that identifies proteins on individual cells suspended in a liquid sample. Often used for blood or bone marrow samples in CLL and leukaemia.
- CLL (chronic lymphocytic leukaemia)
- A slow-growing B-cell cancer that starts in the blood and bone marrow. CD20-positive CLL is a recognised indication for rituximab-based treatment.
Questions that need a longer answer
What if my biopsy shows CD20-negative?
A CD20-negative result means rituximab is unlikely to benefit you, and prescribing it would expose you to real side effects without a realistic prospect of benefit. Your oncologist will recommend a regimen designed for CD20-negative disease. Some lymphomas that initially test CD20-positive can become CD20-negative after treatment, which is one reason a repeat biopsy may be requested if your cancer comes back or stops responding.
I have hepatitis B. Can I still have rituximab?
Possibly, but hepatitis B screening before starting rituximab is mandatory. Rituximab suppresses the immune response to the hepatitis B virus, which can allow it to reactivate — sometimes seriously. If you are hepatitis B surface antigen positive, or have markers suggesting past infection, your team will usually prescribe antiviral medicine before treatment begins and continue it through treatment and for a period afterwards. Tell your oncologist about any history of hepatitis B, even if you were told it had resolved.
Does it matter if I have had rituximab before?
It can. Many patients who responded to rituximab in the past can receive it again, sometimes years later. However, if your cancer progressed during or shortly after a rituximab-containing regimen, your oncologist will consider whether a different approach is more appropriate. There is no fixed rule. The decision depends on how your cancer behaved the last time, your overall health now, and what regimen is being planned alongside it.
Can I have rituximab if I am pregnant or trying to conceive?
Rituximab is not given during pregnancy. It crosses the placenta and can affect B-cell development in the baby. If you are pregnant, your oncologist will discuss the timing of treatment carefully, weighing how urgent treatment is against the risk to the pregnancy. If you are trying to conceive or could become pregnant, tell your team before starting. Effective contraception is recommended during treatment and for a period afterwards — your oncologist will specify how long.
My doctor mentioned R-CHOP. What does the R stand for?
The R in R-CHOP stands for rituximab. R-CHOP is a regimen commonly used for diffuse large B-cell lymphoma and some other B-cell lymphomas, in which rituximab is given alongside four chemotherapy drugs: cyclophosphamide, doxorubicin, vincristine, and prednisolone. Rituximab adds benefit in CD20-positive disease without substantially increasing the toxicity of the chemotherapy component. Your eligibility for R-CHOP rests on the same CD20-positive requirement as rituximab given on its own.
Did you know?
Rituximab was among the first monoclonal antibodies approved for cancer treatment, reaching regulatory approval in the 1990s for B-cell lymphoma.
The WHO includes it on its Model List of Essential Medicines — a designation reserved for treatments considered safe, effective, and necessary for a functioning health system.
Source: WHO Model List of Essential Medicines; NCCN Guidelines for B-cell Lymphomas
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Common questions
Frequently asked questions
Can I take rituximab if I have myeloma?
No. Myeloma is a plasma cell cancer, and plasma cells do not carry CD20. Rituximab has no target in myeloma and is not part of standard myeloma treatment. If you have myeloma and have heard rituximab mentioned, it may have come up in the context of a clinical trial or a misheard drug name. Ask your oncologist to clarify your diagnosis and whether CD20 was tested on your tissue.
How long does CD20 testing take?
CD20 testing is usually done as part of the standard diagnostic panel run on your biopsy tissue, alongside other markers. Results are typically available within one to two weeks of the biopsy. If you already have a copy of your pathology report, CD20 status may be listed in it. Ask your oncologist to point to that specific result and explain what it means for your treatment plan.
What if I have low blood counts — can I still start rituximab?
Low blood counts do not automatically rule out rituximab, but your oncologist will assess whether they are low enough to delay starting. Rituximab further reduces the number of circulating B-cells and can lower certain antibody levels over time. The decision depends on why your counts are low, how low they are, and what other drugs are planned alongside it. Raise this directly with your oncologist before your first infusion.
Is rituximab a tablet or an injection?
Rituximab is given as an intravenous infusion — a drip into a vein, usually over several hours. At CION it is administered as day care, meaning you do not need to stay overnight. A subcutaneous formulation exists and may be used in some settings; if that applies to your plan, your oncologist will explain it. You will not be taking rituximab at home as a tablet or self-injection.
I have diabetes and high blood pressure. Does that disqualify me?
Diabetes and high blood pressure alone do not make you ineligible for rituximab. Eligibility is primarily about CD20 positivity, your cancer type, and the absence of conditions that directly interfere with the drug — such as active severe infection or unmanaged hepatitis B. Your oncologist will review your full medical history before prescribing, and your other conditions will be factored into how you are monitored during treatment.
What should I tell my oncologist before my first infusion?
Tell your team about any history of hepatitis B or C — including if you were told it had resolved. Mention any current infections, all medicines and supplements you are taking including traditional remedies, any previous severe reactions to infusions, and whether you are pregnant or planning to conceive. These are the factors most likely to change whether you start now, start with extra precautions, or wait.