Delayed-onset neutropenia associated with rituximab therapy

被引:115
作者
Chaiwatanatorn, K
Lee, N
Grigg, A
Filshie, R
Firkin, F [1 ]
机构
[1] Univ Melbourne, St Vincents Hosp, Dept Med, Fitzroy, Vic 3065, Australia
[2] St Vincents Hosp, Dept Haematol, Fitzroy, Vic 3065, Australia
[3] St Vincents Hosp, Dept Clin Haematol, Fitzroy, Vic 3065, Australia
[4] Royal Melbourne Hosp, Dept Haematol, Melbourne, Vic, Australia
关键词
neutropenia; rituximab; adverse drug reaction; non-Hodgkin's lymphoma; treatment-related sepsis;
D O I
10.1046/j.1365-2141.2003.04385.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The characteristics of severe neutropenia with a delayed onset following administration of rituximab have been evaluated in 53 consecutively treated patients. All but one patient received rituximab for the treatment of non-Hodgkin's lymphoma. Eight episodes of grade 4 neutropenia were detected between 1 and 5 months after rituximab, when administered alone on five occasions, and on three occasions in combination with chemotherapy, where neutrophil counts had recovered prior to the development of neutropenia. In three episodes, the patients presented with sepsis. Development of neutropenia did not correlate with either the presence of detectable disease or the administration of further treatment. Neutropenia was associated with selective depletion of neutrophil precursors in all but one episode, where it was associated with generalized bone marrow hypoplasia. All episodes developed after a period of either normal or mildly depressed neutrophil counts following treatment with rituximab, and persisted for between several days and several months, before undergoing spontaneous recovery in four instances, and after administration of filgrastim in the remainder. Episodes of neutropenia were associated with disordered immune status manifested by lymphopenia and hypogammaglobulinaemia, raising the possibility that either disturbance of the balance of lymphocyte subsets or an immune dyscrasia induced by rituximab resulted in the development of this type of neutropenia.
引用
收藏
页码:913 / 918
页数:6
相关论文
共 16 条
  • [1] IMMUNOSUPPRESSIVE EFFECTS AND CLINICAL-RESPONSE OF FLUDARABINE IN REFRACTORY CHRONIC LYMPHOCYTIC-LEUKEMIA
    BERGMANN, L
    FENCHEL, K
    JAHN, B
    MITROU, PS
    HOELZER, D
    [J]. ANNALS OF ONCOLOGY, 1993, 4 (05) : 371 - 375
  • [2] CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma.
    Coiffier, B
    Lepage, E
    Brière, J
    Herbrecht, R
    Tilly, H
    Bouabdallah, R
    Morel, P
    Van den Neste, E
    Salles, G
    Gaulard, P
    Reyes, F
    Gisselbrecht, C
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2002, 346 (04) : 235 - 242
  • [3] Coiffier B, 1998, BLOOD, V92, P1927
  • [4] Treatment of patients with low-grade B-cell lymphoma with the combination of chimeric anti-CD20 monoclonal antibody and CHOP chemotherapy
    Czuczman, MS
    Grillo-López, AJ
    White, CA
    Saleh, M
    Gordon, L
    LoBuglio, AF
    Jonas, C
    Klippenstein, D
    Dallaire, B
    Varns, C
    [J]. JOURNAL OF CLINICAL ONCOLOGY, 1999, 17 (01) : 268 - 276
  • [5] Rituximab anti-CD20 monoclonal antibody therapy in non-Hodgkin's lymphoma:: Safety and efficacy of re-treatment
    Davis, TA
    Grillo-López, AJ
    White, CA
    McLaughlin, P
    Czuczman, MS
    Link, BK
    Maloney, DG
    Weaver, RL
    Rosenberg, J
    Levy, R
    [J]. JOURNAL OF CLINICAL ONCOLOGY, 2000, 18 (17) : 3135 - 3143
  • [6] The effect of Rituximab on patients with follicular and mantle-cell lymphoma
    Ghielmini, M
    Schmitz, SFH
    Bürki, K
    Pichert, G
    Betticher, DC
    Stupp, R
    Wernli, M
    Lohri, A
    Schmitter, D
    Bertoni, F
    Cerny, T
    [J]. ANNALS OF ONCOLOGY, 2000, 11 : 123 - 126
  • [7] Optimizing the use of rituximab for treatment of B-cell non-Hodgkin's lymphoma:: A benefit-risk update
    Kunkel, L
    Wong, A
    Maneatis, T
    Nickas, J
    Brown, T
    Grillo-López, A
    Benyunes, M
    Grobman, B
    Dillman, RO
    [J]. SEMINARS IN ONCOLOGY, 2000, 27 (06) : 53 - 61
  • [8] Maloney DG, 1997, BLOOD, V90, P2188
  • [9] Rituximab chimeric Anti-CD20 monoclonal antibody therapy for relapsed indolent lymphoma:: Half of patients respond to a four-dose treatment program
    McLaughlin, P
    Grillo-López, AJ
    Link, BK
    Levy, R
    Czuczman, MS
    Williams, ME
    Heyman, MR
    Bence-Bruckler, I
    White, CA
    Cabanillas, F
    Jain, V
    Ho, AD
    Lister, J
    Wey, K
    Shen, D
    Dallaire, BK
    [J]. JOURNAL OF CLINICAL ONCOLOGY, 1998, 16 (08) : 2825 - 2833
  • [10] FLUDARABINE-RELATED AUTOIMMUNE HEMOLYTIC-ANEMIA IN PATIENTS WITH CHRONIC LYMPHOCYTIC-LEUKEMIA
    MYINT, H
    COPPLESTONE, JA
    ORCHARD, J
    CRAIG, V
    CURTIS, D
    PRENTICE, AG
    HAMON, MD
    OSCIER, DG
    HAMBLIN, TJ
    [J]. BRITISH JOURNAL OF HAEMATOLOGY, 1995, 91 (02) : 341 - 344