Early-onset neutropenia after rituximab therapy for bullous pemphigoid

Abstract

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Iranian guideline for rituximab therapy in pemphigus patients

“…Late and much rarer, early neutropenia has been reported in RTXtreated patients (Adler, Crew, & Woodley, 2018;Khosravi et al, 2017;Monaco, Jones, & Rigby, 2016). Although usually self-limited, in the case of severe neutropenia concomitant with systemic infections, granulocyte-macrophage colony-stimulating factor (GM-CSF) administration is recommended besides infection control (Grade A).…”

A case of late-onset neutropenia secondary to rituximab in a patient with mucous membrane pemphigoid

“…LON has been reported more frequently than EON, but EON is likely underreported because neutropenia occurring within 4 weeks of RTX was excluded from previous trials 1 . Only 5 cases of RTX-associated neutropenia have been reported in the setting of AIBDs,3, 4, 5, 6 including the present case (Table II); as such, it is difficult to draw definitive conclusions regarding incidence, prognosis, and management in patients with dermatologic disorders. Inferences can best be drawn from populations with rheumatic disorders, whose clinical characteristics and treatments likely have the greatest overlap with AIBDs, but current knowledge is limited.…”

“…True incidence is confounded, however, by the retrospective nature of studies, varying definitions of LON used, and diverse populations. The incidence of EON is difficult to assess because there have been only 8 reported cases3, 8 and 1 indeterminate case 6 . The mechanism of RTX-associated neutropenia is unknown, and the heterogeneity of cases precludes conclusive assessment of contributing factors 1 …”

“…A history of neutropenia before RTX has not been associated with development of LON 7 . Although many patients with RTX-associated neutropenia have been female,2, 3, 8 no association between LON and sex has been found 7 . LON has been associated with an immunoglobulin G Fc receptor polymorphism, which may lead to enhanced neutrophil destruction 1 …”

“…Definitions of early-onset neutropenia (EON) and late-onset neutropenia (LON) have been variable in the literature (Table I), with presentation ranging from an asymptomatic laboratory test value to critical illness. Few cases of RTX-associated neutropenia in the setting of AIBDs have been reported 3, 4, 5, 6. Here, we present a case of LON secondary to RTX occurring in a patient with mucous membrane pemphigoid (MMP), a condition in which RTX-associated neutropenia has not been reported to our knowledge.…”