Hematology
Contributions
Type: Publication Only
Background
Rituximab (R) is a monoclonal antibody that binds the CD20 antigen on all peripheral B cells. Its favorable toxicity profile and effectiveness have led to its wide use in induction and maintenance regimens for Non Hodgkin Lymphoma (NHL).
Aims
This retrospective single center study aimed to evaluate the hypogammaglobulinemia (hypoIg) associated with R use.
Methods
We performed serial quantitative serum immunoglobulin (SIg) concentration at the baseline, after chemotherapy, during and after R maintenance therapy.
IgG, IgA and IgM deficit were respectively defined by level below 700 mg/dL, 70 mg/dL and 40 mg/dL. Symptomatic patients were defined as having 2 or more non-neutropenic infections in a 6-month period after or during R.
Results
123 patients with indolent NHL and SIgG studies were analyzed, 47,1% were relapsed or refractory.
The median age of patients was 60 years (range: 28-80). The histologies included follicular lymphoma (FL) (n=77), small lymphocytic lymphoma (SLL) (n=14), marginal zone lymphoma (ML) (n=20), mantle cell lymphoma (MCL) (n=12).
Patients received a median of 13 doses of R (range: 6-27). The median follow-up of surviving patients was 4,4 years.
Before treatment with R, 11/123 (8,9%) had low SIgG levels (5 FL, 1 MCL, 4 SLL, 1ML) and 3/11 (27,2%) required, during R maintenance treatment, Intravenous Immunoglobulin (IVIG) administration. After R-chemotherapy, IgG deficiency appeared in 29/123 (28,4%), 2/29 needed IVIG. After or during R maintenance 25/123 (20,3%) showed IgG deficiency after a median of 9 R cumulative doses; the deficit occurred in the 80% (20/25) within the fourth R maintenance dose and in no one after the sixth R administration. In this category, 10/25 (40%) were symptomatic and 4/25 (16%) required IVIG.
All 10 patients who needed IVIG showed at least two Ig isotypes deficiency.
Summary
We observed that R administration was associated with a high risk of hypoIg. In addition, we found that the number of R doses correlated to the development of symptomatic hypoIg. Finally we observed that the risk of hypoIg increased in patients who received maintenance R. The decision to introduce therapy with IVIG in non-neutropenic patients was related to repeated episodes of infection. HypoIg often is underestimated also for the presence of confounding symptoms. Our study suggests that the baseline and periodic Ig monitoring should be considered in these patients subset.
Keyword(s): Immunodeficiency, Maintenance, NHL, Rituximab
Session topic: Publication Only
Type: Publication Only
Background
Rituximab (R) is a monoclonal antibody that binds the CD20 antigen on all peripheral B cells. Its favorable toxicity profile and effectiveness have led to its wide use in induction and maintenance regimens for Non Hodgkin Lymphoma (NHL).
Aims
This retrospective single center study aimed to evaluate the hypogammaglobulinemia (hypoIg) associated with R use.
Methods
We performed serial quantitative serum immunoglobulin (SIg) concentration at the baseline, after chemotherapy, during and after R maintenance therapy.
IgG, IgA and IgM deficit were respectively defined by level below 700 mg/dL, 70 mg/dL and 40 mg/dL. Symptomatic patients were defined as having 2 or more non-neutropenic infections in a 6-month period after or during R.
Results
123 patients with indolent NHL and SIgG studies were analyzed, 47,1% were relapsed or refractory.
The median age of patients was 60 years (range: 28-80). The histologies included follicular lymphoma (FL) (n=77), small lymphocytic lymphoma (SLL) (n=14), marginal zone lymphoma (ML) (n=20), mantle cell lymphoma (MCL) (n=12).
Patients received a median of 13 doses of R (range: 6-27). The median follow-up of surviving patients was 4,4 years.
Before treatment with R, 11/123 (8,9%) had low SIgG levels (5 FL, 1 MCL, 4 SLL, 1ML) and 3/11 (27,2%) required, during R maintenance treatment, Intravenous Immunoglobulin (IVIG) administration. After R-chemotherapy, IgG deficiency appeared in 29/123 (28,4%), 2/29 needed IVIG. After or during R maintenance 25/123 (20,3%) showed IgG deficiency after a median of 9 R cumulative doses; the deficit occurred in the 80% (20/25) within the fourth R maintenance dose and in no one after the sixth R administration. In this category, 10/25 (40%) were symptomatic and 4/25 (16%) required IVIG.
All 10 patients who needed IVIG showed at least two Ig isotypes deficiency.
Summary
We observed that R administration was associated with a high risk of hypoIg. In addition, we found that the number of R doses correlated to the development of symptomatic hypoIg. Finally we observed that the risk of hypoIg increased in patients who received maintenance R. The decision to introduce therapy with IVIG in non-neutropenic patients was related to repeated episodes of infection. HypoIg often is underestimated also for the presence of confounding symptoms. Our study suggests that the baseline and periodic Ig monitoring should be considered in these patients subset.
Keyword(s): Immunodeficiency, Maintenance, NHL, Rituximab
Session topic: Publication Only