Incidence of late onset neutropenia associated with rituximab use in B cell lymphoma patients undergoing autologous stem cell transplantation

Abstract

Reversible late onset neutropenia associated with rituximab has been reported with incidence rates varying from 15 to 70% in B cell lymphoma patients receiving autologous stem cell transplantation. We conducted a retrospective descriptive study at one tertiary care center in adult B cell lymphoma patients treated with rituximab and autologous stem cell transplantation between 1 January 2004 and 30 June 2014. Late onset neutropenia was defined as an absolute neutrophil count <1.0 × 10 cells/L after neutrophil engraftment and less than six months post autologous stem cell transplantation. The primary objective was to determine the incidence of late onset neutropenia. The secondary objectives were to examine whether the use of rituximab with re-induction therapy, mobilization or high dose chemotherapy regimens increased the risk for late onset neutropenia, and to evaluate infectious complications. Of 315 subjects, 92 (29.2%) developed late onset neutropenia. Mobilization regimens containing rituximab (OR 2.90 95% CI: 1.31-6.40), high dose chemotherapy containing rituximab (OR 1.87 95% CI: 1.14-3.05), and exposure to rituximab in either or both regimens (OR 3.05 95% CI: 1.36-6.88) significantly increased the risk of late onset neutropenia. While neutropenic, 17.4% experienced an infection, 7.6% experienced febrile neutropenia, and 5.4% were hospitalized. In conclusion, rituximab with mobilization or high dose chemotherapy may increase the risk of late onset neutropenia post autologous stem cell transplantation.

Subcutaneous rituximab given to patients for other indications than CD20+ B-cell lymphoma: A monocentric study of 20 cases

“…Our study is the first to address the feasibility of SC-R in other populations than CD20+ B-Cell lymphoma patients. SC-R seems to demonstrate a comparable efficacy/safety profile as IV-R. LON incidence was comparable with previous reports [8] . A costing study should be envisaged to demonstrate cost saving as it is the case for diffuse large B-cell lymphoma [9] .…”

An Update on the Incidence, Risk Factors and Mechanisms of Rituximab- Associated Neutropenia

“…In recent years, several retrospective studies have been conducted on LON, and episodes of LON may lead to clinically significant disease and may influence clinical decision making, so it is important that we now have an understanding of the epidemiological and clinical characteristics and management of LON. In several recent reports of hematologic and AIDs, we have listed their epidemiologic and clinical features in Table 2 based on different case series [19,[24][25][26][27][28][29] . However, the actual incidence may be higher than noticed due to the asymptomatic course of LON episodes and the possible faster recovery of patients from ANC.…”

“…According to the information of patients in Table 2, we classify the etiology of RAN into autoimmune or inflammatory and lymphoma [19,[24][25][26][27][28][29] . In Table 3, the differences in the onset of LON between these two categories of patients are described in terms of the incidence rate, age of onset, onset time (from the last dose of RTB), duration of LON, and ANC median lowest point.…”

“…The risk of LON P r e p r i n t would increase by 3.05 times. Although the incidence of RAN due to RTB therapy varies in document, ASCT has been considered as a latent risk factor [27] .…”

“…Of these patients, febrile neutropenia was diagnosed in 7 patients, 5 patients were hospitalized, and 1 patient developed sepsis [27] . G-CSF was administered to 37 patients, and no patient died from the infection [27] . Abdulkader et al described LON in 5 of 108 patients with RA, all 5 of whom had seropositive celiac disease [25] .…”