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Rituximab associated neutropenia: description of three cases and an insight into the underlying pathogenesis.

Weissmann-Brenner A, Brenner B, Belyaeva I, Lahav M, Rabizadeh E - Med. Sci. Monit. (2011)

Bottom Line: Control plasma did not have such an effect.After recovery the patient's plasma did not inhibit colony formation, similar to control.RAN is a clinically significant side effect.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel. alinabrenner@yahoo.com

ABSTRACT

Background: To describe Rituximab associated neutropenia (RAN), and to explore its underlying mechanism.

Case report: We describe three patients with RAN. The effect of patient's plasma on colony forming unit, Granulocyte-Monocyte (CFU-GM) was measured by the addition of plasma to the culture of a healthy bone-marrow. Repeated tests were performed after recovery of white count. In the leukopenic period the patient's plasma inhibited CFU growth completely. Control plasma did not have such an effect. Addition of patient's cell supernatant to bone marrow cells did not change the number of CFU. The same effect was demonstrated in normal control. After recovery the patient's plasma did not inhibit colony formation, similar to control.

Conclusions: RAN is a clinically significant side effect. It may take place during treatment or several months afterwards. Circulating antibodies in the plasma may be responsible for this unique BM toxicity.

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Related in: MedlinePlus

Total leukocytes and the number of neutrophils. The patient no’ 1 blood count (CBC) showed variable number of leukocytes and neutrophils in different periods of treatment. The number of these cells at the dates of blood count is shown. The arrows show: 1: The last chemotherapy. 2: The last Rituximab. 3, 4,6: Patient’s plasma collection before Neopogen (G-CSF) administration. 4,5, 6,7: Neopogen (G-CSF) administration. 8: Patient’s plasma collection after recovery.
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f1-medscimonit-17-11-cs133: Total leukocytes and the number of neutrophils. The patient no’ 1 blood count (CBC) showed variable number of leukocytes and neutrophils in different periods of treatment. The number of these cells at the dates of blood count is shown. The arrows show: 1: The last chemotherapy. 2: The last Rituximab. 3, 4,6: Patient’s plasma collection before Neopogen (G-CSF) administration. 4,5, 6,7: Neopogen (G-CSF) administration. 8: Patient’s plasma collection after recovery.

Mentions: A 33 year old woman suffering from diffuse large B-cell mediastinal non-Hodgkin’s lymphoma (NHL) performed a complete blood count (CBC) on a routine follow up 78 days after completing treatment of chemotherapy and Rituximab, and was in complete clinical remission. Results revealed leukopenia of 800/mm3 and neutropenia of 100/mm3. Hemoglobin and thrombocytes levels were normal (12.4 gr/dL and 332,000/ml, respectively). Glucose, electrolytes, kidney and liver function tests were all within normal range. Serology for Parvovirus B19 was negative. A subsequent CBC two days later was similar (Figure 1). A few hours later she developed fever of 40°C and was admitted.


Rituximab associated neutropenia: description of three cases and an insight into the underlying pathogenesis.

Weissmann-Brenner A, Brenner B, Belyaeva I, Lahav M, Rabizadeh E - Med. Sci. Monit. (2011)

Total leukocytes and the number of neutrophils. The patient no’ 1 blood count (CBC) showed variable number of leukocytes and neutrophils in different periods of treatment. The number of these cells at the dates of blood count is shown. The arrows show: 1: The last chemotherapy. 2: The last Rituximab. 3, 4,6: Patient’s plasma collection before Neopogen (G-CSF) administration. 4,5, 6,7: Neopogen (G-CSF) administration. 8: Patient’s plasma collection after recovery.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539507&req=5

f1-medscimonit-17-11-cs133: Total leukocytes and the number of neutrophils. The patient no’ 1 blood count (CBC) showed variable number of leukocytes and neutrophils in different periods of treatment. The number of these cells at the dates of blood count is shown. The arrows show: 1: The last chemotherapy. 2: The last Rituximab. 3, 4,6: Patient’s plasma collection before Neopogen (G-CSF) administration. 4,5, 6,7: Neopogen (G-CSF) administration. 8: Patient’s plasma collection after recovery.
Mentions: A 33 year old woman suffering from diffuse large B-cell mediastinal non-Hodgkin’s lymphoma (NHL) performed a complete blood count (CBC) on a routine follow up 78 days after completing treatment of chemotherapy and Rituximab, and was in complete clinical remission. Results revealed leukopenia of 800/mm3 and neutropenia of 100/mm3. Hemoglobin and thrombocytes levels were normal (12.4 gr/dL and 332,000/ml, respectively). Glucose, electrolytes, kidney and liver function tests were all within normal range. Serology for Parvovirus B19 was negative. A subsequent CBC two days later was similar (Figure 1). A few hours later she developed fever of 40°C and was admitted.

Bottom Line: Control plasma did not have such an effect.After recovery the patient's plasma did not inhibit colony formation, similar to control.RAN is a clinically significant side effect.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel. alinabrenner@yahoo.com

ABSTRACT

Background: To describe Rituximab associated neutropenia (RAN), and to explore its underlying mechanism.

Case report: We describe three patients with RAN. The effect of patient's plasma on colony forming unit, Granulocyte-Monocyte (CFU-GM) was measured by the addition of plasma to the culture of a healthy bone-marrow. Repeated tests were performed after recovery of white count. In the leukopenic period the patient's plasma inhibited CFU growth completely. Control plasma did not have such an effect. Addition of patient's cell supernatant to bone marrow cells did not change the number of CFU. The same effect was demonstrated in normal control. After recovery the patient's plasma did not inhibit colony formation, similar to control.

Conclusions: RAN is a clinically significant side effect. It may take place during treatment or several months afterwards. Circulating antibodies in the plasma may be responsible for this unique BM toxicity.

Show MeSH
Related in: MedlinePlus