Incidence and influencing factors of late-onset neutropenia after Rituximab treatment in children with primary nephrotic syndrome
10.3760/cma.j.cn101070-20241122-00778
- VernacularTitle:利妥昔单抗治疗儿童原发性肾病综合征后迟发性中性粒细胞减少症的发生率及影响因素
- Author:
Yan YANG
1
;
Xiuxin LIN
;
Ying LIN
;
Huifang CHEN
;
Yan CHEN
;
Yang YANG
;
Haitao BAI
Author Information
1. 厦门大学附属第一医院儿科，厦门市儿科重点实验室，厦门大学医学院儿童医学研究所，厦门 361003
- Publication Type:Journal Article
- Keywords:
Child;
Rituximab;
Nephrotic syndrome;
Neutropenia;
Influencing factor
- From:
Chinese Journal of Applied Clinical Pediatrics
2025;40(9):663-667
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the incidence, clinical management and influencing factors of late-onset neutropenia (LON) in children with primary nephrotic syndrome (PNS) after Rituximab (RTX) treatment.Methods:A retrospective case-control study was conducted.The clinical data of PNS children who received RTX treatment at the First Affiliated Hospital of Xiamen University from March 2020 to August 2024 and were followed up for at least 6 months were collected.The RTX regimen was a single dose of 375 mg/m 2 with a maximum dose of 500 mg, and an additional dose was administered when the reexamination showed that peripheral blood CD19 + B cells were ≥ 1% or nephrotic syndrome relapsed.The patients were divided into an LON group and a non-LON group according to the presence or absence of LON, and then a comparison was made between the groups.The cumulative incidence of LON was estimated by the Kaplan-Meier method.Univariate and multivariate Logistic regression methods were used to identify the influencing factors of LON.Receiver operating characteristic (ROC) curves were plotted to assess the value of each influencing factor for predicting LON. Results:A total of 65 PNS patients were included.The incidence of LON was 19.3%(27/140) after 140 RTX treatment courses, and the first LON appeared 95.0 (64.0, 115.0) days after RTX treatment.Forty-nine patients received repeated RTX treatment.The incidence rates of LON after the first course, the second course, and the third course of RTX were 27.7%(18/65), 10.2%(5/49), and 18.8%(3/16), respectively, with no statistically significant difference ( χ2=5.764, P>0.05). There was also no significant difference in the incidence of LON between patients taking and not taking combined immunosuppressive agents after RTX treatment [35.3%(6/17) vs.37.8%(17/45), χ2=0.033, P>0.05]. Compared with the non-LON group, the LON group had a higher incidence of infections [48.1%(13/27) vs.15.0%(17/113), χ2=14.17, P<0.01], but no serious outcomes were observed in both groups.Multivariate Logistic analysis suggested that the age at treatment with RTX was an independent risk factor for LON after RTX treatment ( OR=0.763, 95% CI: 0.592-0.982). The area under the ROC curve of the age at treatment with RTX for predicting LON was 0.767 (95% CI: 0.628-0.906), with an optimal cutoff of 6.6 years, a sensitivity of 70.6%, and a specificity of 80.0%. Conclusions:The incidence of LON in PNS children after RTX treatment may be underestimated.Children who develop LON are at a higher risk of infections, but the prognosis is favorable.The age at treatment with RTX≤6.6 years is an independent risk factor for LON in PNS children.Close monitoring of neutrophil counts should be emphasized in younger PNS patients receiving RTX therapy.
