title: Profound hypogammaglobulinemia 7 years after treatment for indolent lymphoma.
abstract: We report a case of a previously healthy 31 year old woman diagnosed with Stage IIIA follicular lymphoma treated with fludarabine in combination with cyclophosphamide and rituximab who presented seven years after the completion of therapy with CD4 count depression, panhypogammaglobulinema and a history of recurrent sinus infections. We performed comprehensive immunophenotypic analysis and found her to have only 1.2% switched (normal 21 +/- 8%) and 4.7% non-switched (11 +/- 4%) memory B cells with 92% of B cells belonging to the naïve compartment. We have previously evaluated reconstitution of the B cell compartment during the 6 to 12 month recovery period after treatment with rituximab and found a similar immunophenotypic pattern. In our patient, this defect was observed seven years after the administration of rituximab in combination with an alkylating agent and purine analog. The patient was started on monthly intravenous immunoglobulin treatments with complete resolution of her symptoms.
authors.affiliation: University of Rochester, Hematology/Oncology, Rochester, New York 14642, USA. alison walker@urmc.rochester.edu
authors.forename: Alison R
authors.initials: AR
authors.lastname: Walker
authors.forename: Anatole
authors.initials: A
authors.lastname: Kleiner
authors.forename: Lynn
authors.initials: L
authors.lastname: Rich
authors.forename: Charlene
authors.initials: C
authors.lastname: Conners
authors.forename: Richard I
authors.initials: RI
authors.lastname: Fisher
authors.forename: Jennifer
authors.initials: J
authors.lastname: Anolik
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Friedberg
mesh_terms: D000328:Adult; D000361:Agammaglobulinemia / Q000139:chemically induced* / Q000628:therapy; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D016175:B-Lymphocyte Subsets / Q000187:drug effects* / Q000276:immunology; D018791:CD4 Lymphocyte Count; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D017578:Immunoglobulin Class Switching; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007156:Immunologic Memory; D016130:Immunophenotyping; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000276:immunology; D000069283:Rituximab; D012852:Sinusitis / Q000209:etiology; D014740:Vidarabine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D016756:Immunoglobulins, Intravenous; D000069283:Rituximab; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine