Abstract | INTRODUCTION: METHODS: We retrospectively analyzed 189 ITP patients receiving RTX in 3 referral centers in France and conducted a systematic review of 32 studies (results published 2001-2014) reporting the use of RTX for ITP, particularly searching for symptomatic secondary hypogammaglobulinemia. We also searched for case reports of hypogammaglobulinemia after RTX initiation for ITP. RESULTS: Of the 189 patients, 3 showed symptomatic hypogammaglobulinemia more than 2years after RTX infusion (initial immunoglobulin level was normal). All 3 presented recurrent severe infections. In 2, the outcome suggested common variable immunodeficiency. In patient 3, the peripheral blood lacked CD19(+)CD20(+) B cells and the bone-marrow B-cell precursor level was impaired. Among 1245 ITP patients in the literature who received RTX for ITP, gammaglobulin level was monitored before and after RTX initiation for 351 (28%). For 192 (55%), dosages were available and we identified 21 patients with secondary hypogammaglobulinemia, usually not symptomatic, 14 of whom had received concomitant dexamethasone. Finally, we found 4 case reports of ITP and symptomatic hypogammaglobulinemia possibly related to RTX according to the authors. CONCLUSIONS: This large analysis led us to recommend monitoring serum immunoglobulin level before and repeatedly after RTX initiation for ITP. Physicians should be aware of hypogammaglobulinemia as a rare but severe complication of RTX.
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Authors | Romain Levy, Matthieu Mahévas, Lionel Galicier, David Boutboul, Julien Moroch, Valentine Loustau, Constance Guillaud, Laeticia Languille, Olivier Fain, Philippe Bierling, Medhi Khellaf, Marc Michel, Eric Oksenhendler, Bertrand Godeau |
Journal | Autoimmunity reviews
(Autoimmun Rev)
Vol. 13
Issue 10
Pg. 1055-63
(Oct 2014)
ISSN: 1873-0183 [Electronic] Netherlands |
PMID | 25183241
(Publication Type: Case Reports, Journal Article, Review, Systematic Review)
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Copyright | Copyright © 2014 Elsevier B.V. All rights reserved. |
Chemical References |
- Antibodies, Monoclonal, Murine-Derived
- Immunosuppressive Agents
- Rituximab
- Hydroxychloroquine
- Prednisone
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Topics |
- Adolescent
- Adult
- Agammaglobulinemia
(chemically induced)
- Antibodies, Monoclonal, Murine-Derived
(adverse effects)
- B-Lymphocytes
(immunology)
- Female
- France
- Humans
- Hydroxychloroquine
(therapeutic use)
- Immunosuppressive Agents
(adverse effects)
- Middle Aged
- Prednisone
(therapeutic use)
- Retrospective Studies
- Rituximab
- Thrombocytopenia
(complications, drug therapy)
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