Background: Rituximab, a monoclonal antibody targeting CD20, has revolutionized the management of B-cell lymphoproliferative disorders and some immune conditions, significantly improving disease control and patient survival. Beyond its indisputable therapeutic benefits, rituximab can cause serious pulmonary adverse events, particularly interstitial lung disease (R-ILD). Diagnosing R-ILD is challenging due to nonspecific clinical and imagistic features, and its true incidence is possibly underestimated.Methods: We conducted a systematic review to synthesize current evidence on R-ILD, focusing on its incidence, diagnostic approaches, management strategies and clinical outcomes. A comprehensive search of PubMed/MEDLINE was performed using the term “rituximab induced interstitial lung disease” through August 2025. Relevant abstracts were screened, and full-text articles meeting the inclusion criteria were analyzed.Results: A total of 40 studies were retained after the search and screening, including case reports, case series and cohort studies of R-ILD. This condition was identified in both malignant and autoimmune disorders receiving rituximab, more frequently for combination regimens. Radiological manifestations were heterogeneous, and ground-glass opacities were the dominant pattern. Most R-ILD cases were reversible, but progression to chronic interstitial disease and fatal outcomes are possible. Cohort studies demonstrated variability in incidence, reported instances of successful rituximab reintroduction and suggested a protective effect of prophylactic trimethoprim-sulfamethoxazole against opportunistic pneumonitis.Conclusions: Although rare, R-ILD is a clinically significant complication of rituximab therapy. Early recognition and multidisciplinary management are essential, as most patients respond to corticosteroids, while severe cases may progress to respiratory failure or fatal outcomes.
背景：利妥昔单抗是一种靶向CD20的单克隆抗体，其应用彻底改变了B细胞淋巴增殖性疾病及部分免疫性疾病的治疗格局，显著提升了疾病控制率与患者生存率。然而，除确切的治疗获益外，利妥昔单抗也可能引发严重的肺部不良事件，尤其是间质性肺病（R-ILD）。由于该病临床表现与影像学特征缺乏特异性，诊断存在挑战，其真实发病率可能被低估。 方法：本研究通过系统性综述，旨在整合当前关于R-ILD的循证证据，重点关注其发病率、诊断方法、管理策略及临床结局。我们在PubMed/MEDLINE数据库中，以“利妥昔单抗诱导的间质性肺病”为检索词，对截至2025年8月的文献进行了全面检索。对相关摘要进行筛选后，对符合纳入标准的全文文献进行了分析。 结果：经检索与筛选，最终纳入40项研究，包括R-ILD的病例报告、病例系列及队列研究。该并发症可见于接受利妥昔单抗治疗的恶性疾病与自身免疫性疾病患者中，联合治疗方案中更为常见。影像学表现具有异质性，其中磨玻璃影为主要表现模式。多数R-ILD病例具有可逆性，但亦可能进展为慢性间质性肺病或导致死亡结局。队列研究显示其发病率存在差异，报道了成功再次使用利妥昔单抗的案例，并提示预防性使用甲氧苄啶-磺胺甲噁唑可能对机会性肺炎具有保护作用。 结论：尽管罕见，R-ILD是利妥昔单抗治疗中具有重要临床意义的并发症。早期识别与多学科综合管理至关重要，因多数患者对皮质类固醇治疗有反应，而重症病例可能进展至呼吸衰竭或死亡。
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