Rituximab induced neutropenia – pro
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