title: Does rituximab aggravate pre-existing hypogammaglobulinaemia?
abstract: Rituximab, an anti-CD20 chimeric antibody, is the first monoclonal agent to be used in the therapy of cancer. It has been hailed as one of the most important therapeutic developments of the decade. While transient peripheral B cell depletion is common after rituximab therapy, immunoglobulin levels are generally not affected. This is because CD20 is expressed on pre-B and mature B lymphocytes but not on stem cells or plasma cells. Two adult patients with pre-existing primary antibody deficiency who presented with recurrent infections immediately following rituximab use for the treatment of refractory idiopathic thrombocytopenic purpura (ITP) are described. Both were previously treated with various immunosuppressive agents without any notable infective problems. However, a few weeks after treatment with rituximab, these patients presented with clinically significant immunodeficiency requiring intravenous immunoglobulin replacement therapy. This striking temporal relationship between rituximab administration and onset of infections suggests that rituximab has accelerated the presentation of immune deficiency in these patients. Increased vigilance around the use of newer immunomodulatory agents such as rituximab is recommended.
authors.affiliation: Department of Immunology, Heartlands Hospital, Birmingham B9 5SS, UK. lavanya.diwakar@heartofengland.nhs.uk
authors.forename: Lavanya
authors.initials: L
authors.lastname: Diwakar
authors.forename: Sheryl
authors.initials: S
authors.lastname: Gorrie
authors.forename: Alex
authors.initials: A
authors.lastname: Richter
authors.forename: Oliver
authors.initials: O
authors.lastname: Chapman
authors.forename: Paul
authors.initials: P
authors.lastname: Dhillon
authors.forename: Fayza
authors.initials: F
authors.lastname: Al-Ghanmi
authors.forename: Sadia
authors.initials: S
authors.lastname: Noorani
authors.forename: Mamidipudi T
authors.initials: MT
authors.lastname: Krishna
authors.forename: Aarnoud
authors.initials: A
authors.lastname: Huissoon
mesh_terms: D000328:Adult; D000361:Agammaglobulinemia / Q000139:chemically induced*; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D009894:Opportunistic Infections / Q000139:chemically induced; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy*; D012008:Recurrence; D000069283:Rituximab
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab