Neutropenia has been well reported with Rituxan in CLL. In these reports it ws usually associated with agressive regimens that incorpoorted Rituxan. The use of intensive primary chemotherapy regimen was a risk factor. Neutropenia was generally self-limited and not associated with severe infections. I did not find any reports of using G-CSF to treat this condition and in the absence of dicumented infection, it may not be of any benefit. Since an immunologic mechanism, suc as induction of anti-neutrophil antiboides can be potentially invovled, Rituxan should be discontinued, especially in the maintenance situations, in which benefit is still uncertain.
Voog, Eric, Morschhauser, Franck, Solal-Celigny, Philippe, Benyunes, Mark C., Multani, Pratik S., Saunders, Andrew
Neutropenia in Patients Treated with Rituximab
N Engl J Med 2003 348: 2691-2694
Nitta, E, Izutsu, K, Sato, T, Ota, Y, Takeuchi, K, Kamijo, A, Takahashi, K, Oshima, K, Kanda, Y, Chiba, S, Motokura, T, Kurokawa, M (2007). A high incidence of late-onset neutropenia following rituximab-containing chemotherapy as a primary treatment of CD20-positive B-cell lymphoma: a single-institution study. Ann Oncol 18: 364-369
Marotte, H, Paintaud, G, Watier, H, Miossec, P (2008). Rituximab-related late-onset neutropenia in a patient with severe rheumatoid arthritis. Ann Rheum Dis 67: 893-894