HOMEPRODUCTSCOMPANYCONTACTFAQResearchDictionaryPharmaSign Up FREE or Login

Profound symptomatic hypogammaglobulinemia: a rare late complication after rituximab treatment for immune thrombocytopenia. Report of 3 cases and systematic review of the literature.

AbstractINTRODUCTION:
B-cell depletion with rituximab (RTX) is widely used to treat autoimmune diseases, especially as second-line therapy for immune thrombocytopenia (ITP). The incidence of RTX-induced hypogammaglobulinemia is unknown because of heterogeneous follow-up and confounding factors such as concomitant immunosuppressive treatments in most patients. We describe 3 cases and attempted to determine the incidence of RTX-induced hypogammaglobulinemia by a systematic review of the literature.
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.
AuthorsRomain 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
JournalAutoimmunity reviews (Autoimmun Rev) Vol. 13 Issue 10 Pg. 1055-63 (Oct 2014) ISSN: 1873-0183 [Electronic] Netherlands
PMID25183241 (Publication Type: Case Reports, Journal Article, Review, Systematic Review)
CopyrightCopyright © 2014 Elsevier B.V. All rights reserved.
Chemical References
  • Antibodies, Monoclonal, Murine-Derived
  • Immunosuppressive Agents
  • Rituximab
  • Hydroxychloroquine
  • Prednisone
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)

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!


Choose Username:
Email:
Password:
Verify Password:
Enter Code Shown: