Delayed-Onset Neutropenia in a Patient Receiving Rituximab as Treatment for Refractory Kidney Transplantation

Mitsuhata, Naoki; Fujita, Reiko; Ito, Seiichi; Mannami, Makoto; Kojima, Kazushi

doi:10.1097/01.tp.0000184275.81396.45

Cited by 26 publications

(24 citation statements)

References 7 publications

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“…As a complication, late-onset neutropenia has been reported after administration of 150 mg/m 2 RIT in a renal transplant recipient [19,20]. The authors of that study suggested that 375 mg/ m 2 may be an excessive dosage for renal transplant recipients [19,20]. Segev et al reported favorable outcomes in four cases of ABO-incompatible renal transplantation without splenectomy or RIT [21].…”

Section: Discussionmentioning

confidence: 99%

Impact of low-dose rituximab on splenic B cells in ABO-incompatible renal transplant recipients

Toki¹,

Ishida²,

Horita³

et al. 2009

Transplant International

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Summary The purpose of this study was to assess the effect of a low‐dose rituximab (RIT) at <375 mg/m2 on B cells in the spleen and peripheral blood. Five renal transplant recipients received a single dose of RIT at 10, 15, 35, 150, or 300 mg/m2 3–13 days before transplantation. One patient who received the same immunosuppressive regimen except for RIT was also enrolled as a control. Splenectomy was performed at the time of transplantation in all patients. The B‐cell count in the peripheral blood was analysed with a fluorescence‐activated cell sorter using anti‐CD19 antibodies, and the B cells in the spleen were analysed by immunohistochemistry using anti‐CD20 and ‐CD79a antibodies. All but one dosage (10 mg/m2) of RIT completely eliminated B cells from the circulation within 30 days. Immunohistochemical examination of the spleen showed a marked reduction of B cells in the white pulps in all five recipients compared with that in the control patient. The observations in this study indicated that RIT has a potent effect of depleting B cells in the spleen and peripheral blood at low‐doses of <375 mg/m2.

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Section: Discussionmentioning

confidence: 99%

Impact of low-dose rituximab on splenic B cells in ABO-incompatible renal transplant recipients

Toki¹,

Ishida²,

Horita³

et al. 2009

Transplant International

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“…9,10,12 There are few reports on rituximab-related LON in kidney transplant recipients, [14][15][16][17][18] with some of these patients being given rituximab for desensitization before ABO-or HLA-incompatible transplant. 14,15 This is the first study to compare LON in kidney transplant recipients who had been treated with rituximab for acute antibody-mediated rejection versus control patients, which is important due to the emerging area of rituximab administration in kidney transplant patients.…”

Section: Discussionmentioning

confidence: 99%

“…14 In the study by Kabei and associates, LON occurred in 12 of 25 (48%) kidney transplant recipients who received 1 to 2 low doses of 150 mg/m 2 of rituximab for desensitization. 15 One case report 16 and 2 case series 17,18 on kidney transplant recipients who received rituximab for humoral rejection reported rituximab-induced neutropenia in 37.5% (3 of 8 patients) and 33.3% (3 of 9 patients) without using the word LON. These reports on AMR-treated kidney transplant patients had a lack of a control group.…”

Section: Discussionmentioning

confidence: 99%

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Ahmadi

Dashti‐Khavidaki²,

Khatami³

et al. 2017

Exp Clin Transplant

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Objectives: Kidney transplant is a new area for use of rituximab, which is being used to treat acute antibodymediated rejection or as an induction agent in ABOor HLA-incompatible grafts. We report on late-onset neutropenia in rituximab-treated kidney transplant recipients with antibody-mediated rejection. Conclusions: Increased use of rituximab to treat antibody-mediated rejection among kidney transplant recipients requires attention to its late-onset adverse event, neutropenia. Although asymptomatic in some patients, kidney transplant recipients treated concomitantly with plasmapheresis and mycophenolate mofetil are predisposed to hypogammaglobulinemia, and monitoring of patients for infections is required.

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“…Less commonly, antithymocyte globulin, alemtuzumab, rituximab, tacrolimus (TAC), cyclosporine, sirolimus, cotrimoxazole, omeprazole, and angiotensinconverting enzyme inhibitors have been reported to cause neutropenia. [4][5][6][7][8][9][10][11] The contribution of these agents is difficult to assess because they are frequently used in combinations. Remission of neutropenia after drug elimination or discontinuation can be used as indirect evidence.…”

Section: Introductionmentioning

confidence: 99%

Replacement of Mycophenolate Acid With Everolimus in Patients Who Became Neutropenic After Renal Transplant

Savvidaki

Kazakopoulos²,

Papachristou³

et al. 2014

Exp Clin Transplant

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Delayed-Onset Neutropenia in a Patient Receiving Rituximab as Treatment for Refractory Kidney Transplantation

Cited by 26 publications

References 7 publications

Impact of low-dose rituximab on splenic B cells in ABO-incompatible renal transplant recipients

Impact of low-dose rituximab on splenic B cells in ABO-incompatible renal transplant recipients

Untitled

Replacement of Mycophenolate Acid With Everolimus in Patients Who Became Neutropenic After Renal Transplant

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