Rituximab is an anti-CD20 chimeric antibody that is used to treat B cell neoplasms and autoimmune disease. It induces the depletion of B lymphocytes in peripheral blood, with an average recovery time of 6-9 months. There is evidence that some patients have prolonged hypogammaglobulinemia and B-cell deficiency following Rituximab treatment (RT). We examined 10 children who received Rituximab to determine if there immune status fully recovered after treatment.
A retrospective chart review was performed in 10 children that underwent RT for various autoimmune disorders. CBC, immunoglobulins, T and B cells were obtained at least 1 year after the last dose of Rituximab.
The mean follow-up time was 1-4 years. 20 % (2/10) patients had low IgG 1 year or more after the RT. 50% (5/10) patients had low IgM and one patient had low IgA. 50% (5/10) had low CD19 levels 2 years after the last Rituximab dose. 20% (2/10) also had low CD3, CD4 and CD8 levels up to two years after.
After RT, most patients have full recovery of B cells with no residual immune dysfunction. There is limited data in the literature regarding immune dysfunction after RT in children. In our patient sample, 8 children demonstrated some type of immune suppression 1 year or greater after treatment. Obtaining baseline studies prior to RT and close monitoring is important to differentiate RT-induced from an undiagnosed underlying immune dysfunction in these children.