Relapsed Wegener's granulomatosis after rituximab therapy--B cells are present in new pathological lesions despite persistent 'depletion' of peripheral blood.
Wegener's granulomatosis (WG) is a chronic, relapsing, systemic autoimmune disease. Rituximab, a monoclonal antibody against human CD20, has shown promise as a novel treatment for WG. The monitoring of therapeutic B-cell 'depletion' by peripheral blood flow cytometry has been proposed to help monitor rituximab therapy. We report the case of a patient with known WG and granulomatous disease, successfully treated with rituximab, who relapsed whilst peripheral blood monitoring apparently indicated persistent B-cell depletion. Further investigations demonstrated CD20(+) B cells in tissue at sites of active disease. The implications for disease pathogenesis and clinical monitoring of disease are discussed.
Ferraro
Alastair J
AJ
Division of Infection and Immunity, Institute of Biomedical Research, Medical School, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
Smith
Stuart W
SW
Neil
Desley
D
Savage
Caroline O S
CO
D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000378:metabolism; D001402:B-Lymphocytes / Q000378:metabolism; D014890:Granulomatosis with Polyangiitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D007155:Immunologic Factors / Q000627:therapeutic use*; D008168:Lung / Q000000981:diagnostic imaging / Q000378:metabolism; D008212:Lymphocyte Depletion; D008297:Male; D012008:Recurrence; D000069283:Rituximab; D014057:Tomography, X-Ray Computed
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D007155:Immunologic Factors; D000069283:Rituximab