Chimeric Monoclonal Antibody Against CD20 on B-Cells (see Anti-CD20 Therapy, [[Anti-CD20 Therapy]]): results in B-cell depletion (which lasts for several months)
Immunoglobulin Levels Remain Normal: in most cases
Exception: when rituzimab is used prior to stem cell transplant or as maintenance after stem cell transplant, persistent hypogammaglobulinemia is common
Rituximab Use is Associated with Increased Risk of Neutropenia
Rituximab May Also Interfere with T-Cell Function: some data exist to support this mechanism
Epidemiology: rituximab pulmonary toxicity typically develops after a few infusions of the drug and relapses when treatment is resumed
Diagnosis
Bronchoscopy (see Bronchoscopy, [[Bronchoscopy]]): in one patient, CD4+ lymphocytosis was found in the BAL fluid
Open Lung Biopsy: in one case, a pattern of Desquamative Interstitial Pneumonia (see Desquamative Interstitial Pneumonia, [[Desquamative Interstitial Pneumonia]]) was found
Treatment/Prognosis: corticosteroids typically are effective [MEDLINE]
Pneumocytsis Jirovecii Pneumonia (PCP) (see Pneumocystis Jirovecii, [[Pneumocystis Jirovecii]])
Epidemiology: possibly etiologic, reported with rituximab
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Desquamative alveolitis: an unusual complication of treatment with Mabthera. Blood 1999;94:271
Pulmonary complications after autologous transplantation and immunotherapy with rituximab in patients with follicular lymphoma [abstract]. Blood 2000;96:383a
Interstitial pneumonitis related to rituximab therapy. N Engl J Med 2003;348:2690-2691 [MEDLINE]
Fatal intra-alveolar hemorrhage after rituximab in a patient with non-Hodgkin lymphoma. Leukemia Lymphoma 2004;45:2321-2325
Rituximab consolidation after high-dose chemotherapy and autologous blood stem cell transplantation in follicular and mantle cell lymphoma: a prospective, multicenter phase II study. Ann Oncol. 2004;15:1691– 8
Rituximab-induced acute pulmonary fibrosis. Mayo Clin Proc 2004;79:949-953
Interstitial pneumonitis following rituximab therapy for immune thrombocytopenic purpura (ITP). Am J Hematol 2004;77:103-104
A case of interstitial pneumonia induced by rituximab therapy. Int J Hematol 2005;81:169-170
Hypogammaglobulinemia with a selective delayed recovery in memory B cells and an impaired isotype expression after rituximab administration as an adjuvant to autologous stem cell transplantation for non-Hodgkin lymphoma. Eur J Haematol. 2006;77:226-32
High incidence of non-neutropenic infections induced by rituximab plus fludarabine and associated with hypogammaglobu- linemia: a frequently unrecognized and easily treatable complication. Ann Oncol. 2006;17:1424 –7
B-cell depletion for 2 years after autologous stem cell transplant for NHL induces prolonged hypogammaglobulinemia beyond the rituximab maintenance period. Leuk Lymphoma. 2008;49:152–3
Rituximab purging and maintenance combined with auto-SCT: long-term molecular remissions and prolonged hypogamma- globulinemia in relapsed follicular lymphoma. Bone Marrow Transplant. 2009;43:701-8
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Incidence of Hypogammaglobulinemia in Patients Receiving Rituximab and the Use of Intravenous Immunoglobulin for Recurrent Infections. Clin Lymphoma Myeloma Leuk. Dec 28 2012 [MEDLINE]
Rituximab for ANCA-associated vasculitides. Clin Exp Rheumatol. 2014 May-Jun;32(3 Suppl 82):S118-21. Epub 2014 May 16 [MEDLINE]
Rituximab versus azathioprine for maintenance in ANCA-associated vasculitis. N Engl J Med. 2014 Nov 6;371(19):1771-80. doi: 10.1056/NEJMoa1404231 [MEDLINE]