Agranulocytosis unresponsive to growth factors following rituximab in vivo purging

Case Report: High Doses of Intravenous Immunoglobulins as a Successful Treatment for Late Onset Immune Agranulocytosis After Rituximab Plus Bendamustine

“…Treatment in this scenario is controversial. Rose et al (28) reported one case of diffuse large B cell lymphoma that developed LON following autologous stem cell transplantation and responded to cyclosporine. Saikia et al ( 29) also described a case of G-CSF resistant LON in a patient with follicular lymphoma after R maintenance therapy who responded to IVIG.…”

“…Rose et al. ( 28 ) reported one case of diffuse large B cell lymphoma that developed LON following autologous stem cell transplantation and responded to cyclosporine. Saikia et al.…”

Newly developed preconditioning regimen consisting of rituximab, splenectomy and plasmapheresis for non-responders to conventional regimen in ABO-incompatible kidney transplantation

“…The duration between the treatment with rituximab and the onset of neutropenia was ranging from 1 to 266 days (median: 32.5 days), and the duration between its onset and the recovery was ranging from 1 to 154 days (median: 10 days). With respect to the possible mechanism of rituximab-associated neutropenia, the transient production of autoantibodies directed against neutrophils or their precursors [8], T-lymphocyte-specific cellular response against autologous myeloid precursors [9], apoptosis of mature neutrophils through CD95 (Fas) triggering (probably associated with the induction of T-cell large granular lymphocytes) [10], and myelosuppression mediated by rituximab-induced tumor necrosis factor-a release [11] were reported. In the present study, case 7 developed severe neutropenia and thrombocytopenia 18 days after the second infusion of rituximab which recovered by the treatment with G-CSF and g-globulin and platelet infusion.…”

Rituximab for refractory Evans syndrome and other immune‐mediated hematologic diseases

“…T-LGLs can also mediate myelosuppression and neutropenia independently of Fas and Fas ligand interactions, as suggested by their in vitro suppressive effects in neutrophil development [57]. Rose et al reported a case of agranulocytosis following autologous transplantation for diffuse large B-cell lymphoma after in vivo purging with rituximab [58]. The agranulocytosis in this patient was refractory to G-CSF and GM-CSF and eventually responded to cyclosporine, implicating an underlying immune mechanism leading to destruction of myeloid precursors.…”