title: Incidence of Profound Hypogammaglobulinemia and Infection Rate in Lymphoma Patients Following the Combination of Chemotherapy and Rituximab.
abstract: BACKGROUND
  The Anti-CD20 monoclonal antibody Rituximab suppresses B-lymphocytes and may induce hypogammaglobulinemia in treated patients. The incidence and clinical significance of rituximab induced hypogammaglobulinemia in lymphoma patients is underestimated.
  
  
  METHODS
  We retrospectively analyzed the rates of hypogammaglobulinemia, infection and infection-related mortality in 136 lymphoma patients who were treated with a combination of chemotherapy and rituximab.
  
  
  RESULTS
  Rituximab given in more than 8 doses (OR 6.05, 95% CI: 1.24-29.5), relative hypogammaglobulinemia at time of lymphoma diagnosis (OR 4.2, 95% CI: 1.26-14.1) and the combination of fludarabine with rituximab (OR 3.4, 95% CI: 1.24-9.47) were factors significantly associated with prolonged (more than 6 months) hypogammaglobulinemia. The combination of fludarabine and rituximab (OR 6.4, 95% CI: 1.49-27.0) and secondarily prolonged hypogammaglobulinemia (OR 4.5, 95% CI: 1.19-18.5) were found to be predictive factors for severe infections and infection-related mortality.
  
  
  CONCLUSIONS
  These data suggest the importance of following serum immunoglobulin levels before and after combination immuno-chemotherapy, particularly in patients with recurrent infections or relapsed/refractory disease.
authors.affiliation: Hematology Institute, Kaplan Medical Center, 76100 Rehovot, Israel. kalmanph@clalit.org.il.
authors.forename: Kalman
authors.initials: K
authors.lastname: Filanovsky
authors.forename: Edward B
authors.initials: EB
authors.lastname: Miller
authors.forename: Erica
authors.initials: E
authors.lastname: Sigler
authors.forename: Alain
authors.initials: A
authors.lastname: Berrebi
authors.forename: Lev
authors.initials: L
authors.lastname: Shvidel
mesh_terms: D000293:Adolescent; D000328:Adult; D000361:Agammaglobulinemia / Q000139:chemically induced* / Q000453:epidemiology* / Q000276:immunology; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007239:Infections / Q000139:chemically induced / Q000453:epidemiology / Q000276:immunology; D008223:Lymphoma / Q000188:drug therapy* / Q000453:epidemiology* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069283:Rituximab / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000069283:Rituximab