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Erschienen in: Clinical Rheumatology 10/2016

21.05.2016 | Original Article

Rituximab associated late-onset neutropenia—a rheumatology case series and review of the literature

verfasst von: William E. Monaco, Jonathan D. Jones, William F.C. Rigby

Erschienen in: Clinical Rheumatology | Ausgabe 10/2016

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Abstract

Recently in the rheumatology literature, Rituximab (RTX) has been associated with late-onset neutropenia (LON), defined as an absolute neutrophil count (ANC) <1.5 × 109/L at least 4 weeks after the last infusion. We determined the incidence of LON in patients with rheumatic disease at a single tertiary medical center, ascertained patient characteristics including results of bone marrow biopsies performed on four neutropenic patients, and performed a literature review. The incidence at our institution was 6.5 %, similar to that reported in the literature. Bone marrow biopsies from four neutropenic patients had the predominant cell line as lymphocytes, comprising an average of 41 % (range 24–50 %) of the cellular aspirate suggesting that there is a selective reduction in granulopoiesis and maturation arrest at the promyelocyte stage. Sixty percent of patients presented without serious infections, and all survived without adverse sequelae. Treatment with granulocyte colony-stimulating factor shortened time to recover of ANC but did not change overall outcomes. Among 25 patients re-challenged with RTX after resolution of LON, only two developed recurrence of LON. Among patients at our institution and identified from a review of the literature, LON is not usually associated with serious infections that lead to significant adverse outcomes, G-CSF therapy does not appear to be necessary as it does not change outcomes, and RTX re-treatment after recovery from LON appears safe.
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Metadaten
Titel
Rituximab associated late-onset neutropenia—a rheumatology case series and review of the literature
verfasst von
William E. Monaco
Jonathan D. Jones
William F.C. Rigby
Publikationsdatum
21.05.2016
Verlag
Springer London
Erschienen in
Clinical Rheumatology / Ausgabe 10/2016
Print ISSN: 0770-3198
Elektronische ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-016-3313-y

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