Case Report: High Doses of Intravenous Immunoglobulins as a Successful Treatment for Late Onset Immune Agranulocytosis After Rituximab Plus Bendamustine

Frontiers in Immunology

Antonio Salar¹  Juan Jose Rodríguez-Sevilla¹  Ramon Diez-Feijóo¹  Solange Flores¹  Carmen Raya²  Concepcion Fernández-Rodríguez⁴  Luis Colomo⁴  Ana Ferrer⁴ 

[1] Applied Clinical Research in Hematological Malignancies, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain;Banc de Sang i Teixits, Hospital del Mar, Barcelona, Spain;Department of Hematology, Hospital del Mar, Barcelona, Spain;Department of Pathology, Hospital del Mar, Barcelona, Spain;

关键词: immunoglobulin;    Waldenström’s macroglobulinemia;    bendamustine;    agranulocytosis;    rituximab;   

DOI  :  10.3389/fimmu.2021.798251

来源: DOAJ

【 摘 要 】

Late onset neutropenia (LON) related to rituximab or rituximab plus chemotherapy is defined as an unexplained absolute neutrophil count of ≤1.5 × 109/L starting at least four weeks after the last rituximab administration. LON is infrequent and its pathophysiology remains unknown. There are no guidelines or consensus strategies for the optimal management of patients developing LON. The majority of the patients recover promptly with no specific treatment and only some cases need to be managed with granulocytic colony stimulating factor (G-CSF), usually with a rapid response. Here, we describe a 69-year-old patient with Waldenström’s macroglobulinemia who presented a septic event in the context of severe LON after rituximab plus bendamustine. The diagnosed of agranulocytosis was established by bone marrow examination. Interestingly, anti-neutrophil antibodies bound to the patient’s granulocytes were found suggesting an autoimmune mechanism. The patient did not respond to G-CSF but achieved a rapid response after high doses of intravenous immunoglobulins with full white blood cell recovery.

【 授权许可】

Unknown