Clinical analysis of late-onset neutropenia following rituximab
10.3760/cma.j.issn.1008-5734.2018.03.010
- VernacularTitle:利妥昔单抗致迟发性中性粒细胞减少临床分析
- Author:
Jia CONG
1
;
Jingwen WANG
1
Author Information
1. 100730,首都医科大学附属北京同仁医院血液内科
- Publication Type:Journal Article
- Keywords:
Neutropenia;
Rituximab;
Drug-related side effects and adverse reactions
- From:
Adverse Drug Reactions Journal
2018;20(3):210-215
- CountryChina
- Language:Chinese
-
Abstract:
Objective To understand the incidence and clinical characteristics of late-onset neutropnia (LON)caused by rituximab. Methods The medical records of patients treated with rituximab from hospital information system in Beijing Tongren Hospital,Capital Medical University from December 1, 2012 to March 31,2017 were collected and retrospectively analyzed. The criteria for neutropenia was defined as neutrophil count ＜1.5×109/L. Results A total of 166 patients were enrolled,including 94 males and 72 females,16～90 years old and the average age was (63 ± 11)years. Of the 166 patients,158 had B cell lymphoma,6 had immune thrombocytopenia,and 2 had optical neuromyelitis. The number of treatment course of rituximab was 2-16 and the median number of treatment course was 5. Among the 158 patients with B cell lymphoma,37,30,22,and 66 cases were in the Ann Arbor stage Ⅰ,Ⅱ,Ⅲ,and Ⅳ,respectively, and 27 cases had bone marrow infiltration. Of the 166 patients,19 patients (11.4% )developed 20 cases of LON,of which 10 (6% )had grade 3-4 neutropenia(6 cases of grade 3,4 cases of grade 4);the median time for the last use of rituximab to LON occurrence was 56 days (22-105 days),and the median number of the lowest neutrophil count was 0. 95 × 109/L [(0.05-1. 47 )× 109/L ]. Three patients (all grade 4 neutropenia)developed complications (including 1 patient with pneumonia/bacteremia,1 with herpes zoster,and 1 with fever)during neutropenia,and all recovered after use of granulocyte colony-stimulating factor (GCSF)and antibiotics or antiviral treatments. Of 19 LON patients,5 patients(4 cases of grade 4 neutropenia,1 cases of grade 3)received GCSF treatment,14 patients did not receive special intervention, and the median duration of neutropenia was 16 days (5-42 days). The occurrence of LON was not related to age,gender,disease stages and bone marrow infiltration,but the IgM level and B lymphocyte count in LON patients were significantly lower than those in patients without-LON (P ＜0. 001 )6 months after drug withdrawal. Conclusions The rate of LON induced by rituximab was 11.4% in our hospital. The 2-3 grade neutropenia caused by rituximab are mostly self limiting,and the prognosis is good.Patients with 4 grade neutropenia may be complicated with infection,so GCSF therapy is needed.
