title: Late-onset adverse events after a single dose of rituximab in children with complicated steroid-dependent nephrotic syndrome.
abstract: BACKGROUND
  Rituximab (RTX) is regarded as a relatively safe and effective treatment for children with steroid-dependent nephrotic syndrome (SDNS). However, late-onset adverse events after RTX, including neutropenia, hypogammaglobulinemia, and increased risk of infections, have been rarely reported in this cohort.
  
  
  METHODS
  This was a single-center retrospective analysis of adverse events during B-cell depletion periods after a single dose of RTX (375 mg/m2) in 60 patients with complicated SDNS (total 126 doses). After RTX, maintenance therapy with cyclosporine (CsA) or mycophenolate mofetil (MMF) was continued, and prednisolone was discontinued within 6 months. To detect potential drug toxicity, clinical and laboratory parameters were measured before and 1 week after RTX infusion and every month thereafter during B-cell depletion periods (at least 6 months). A single dose of RTX was added if NS relapsed despite maintenance therapy with MMF or CsA after the re-emergence of CD19+ B cells (> 1% of total lymphocytes) in the peripheral blood.
  
  
  RESULTS
  Severe neutropenia (neutrophil count < 500/mm3) was identified in 3 patients and hypogammaglobulinemia (IgG levels < 500 mg/dL) in 9 patients. During B-cell depletion periods (median 5 months; range 1 - 20 months), 2 patients required hospitalization because of bacterial infections. However, no lifethreatening infections were identified in our cohort.
  
  
  CONCLUSIONS
  Although neutropenia and hypogammaglobulinemia should be kept in mind as late-onset adverse events of RTX therapy in patients with complicated SDNS, severe infections during B-cell depletion periods are infrequent when our treatment strategies are implemented.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Fujinaga
authors.forename: Kanako
authors.initials: K
authors.lastname: Ozawa
authors.forename: Koji
authors.initials: K
authors.lastname: Sakuraya
authors.forename: Akifumi
authors.initials: A
authors.lastname: Yamada
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shimizu
mesh_terms: D000293:Adolescent; D000361:Agammaglobulinemia / Q000139:chemically induced*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced*; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D000069283:Rituximab / Q000009:adverse effects*; D013997:Time Factors; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D000069283:Rituximab; D011239:Prednisolone