IntroductionPlasmablasts are an immediate product of B-cell activation that home either to the bone marrow or to the mucosa to secrete antibody as terminally differentiated plasma cells. [1][2][3] In healthy persons, B cells and antibodies protect from pathogens, whereas loss of immunologic tolerance and malignant transformation result in the generation of autoreactive B cells and autoantibody production and development of lymphoma, respectively. Direct targeting of B cells by the chimeric anti-human CD20 antibody rituximab (RTX) has been developed for the treatment of rheumatoid arthritis (RA) and B-cell malignancies. 4,5 However, not all patients respond to RTX therapy, and the efficiency of B-cell depletion in lymphoid tissues as well as the susceptibility of different B-cell subtypes remain of central interest, in particular related to individual unresponsiveness.In RA, depletion of peripheral CD20 ϩ B cells reduces, but does not eliminate, autoimmunity, indicated by subsequent flares and continuous production of autoantibodies. 6 Persisting (auto-) antibodies in patients treated with RTX reflect the continued presence of antibody-secreting cells, whereas it remains unclear whether those are long-lived, CD20 Ϫ plasma cells, eg, residing in the bone marrow, or whether they have been generated de novo from B cells not depleted by RTX. In this context, germinal center B cells of the Peyer patches and peritoneal B1 B cells resisted to RTX treatment in human cd20 tg mice. 7 Depletion of B cells from human lymphoid tissues of systemic immunity, for example, the spleen and lymph nodes by RTX has been described in individual cases. [8][9][10] Thus, the efficiency of global or selective B-cell depletion remains of interest, in particular whether there is a distinct susceptibility of B-cell subsets to RTX within gut-associated lymphoid tissues (GALT).Here, we demonstrate the continued presence of dividing and migratory plasmablasts expressing a mucosal phenotype in the peripheral blood of patients with RA consistent with steady-state plasmablasts 1 after treatment with RTX. These data show that a subset of chronically activated mucosal B lymphocytes carrying highly mutated V H gene rearrangements and secreting antimicrobial immunoglobulin A (IgA) are not deleted by RTX. This reflects the robustness of humoral mucosal immunity during B-cell depletion with RTX and underscores the independent regulation of mucosal immune responses in steady state. The resistance of some mucosal B cells to RTX is apparently not stringently related to RA pathogenesis but could represent a mechanism underlying enhanced RTX resistance in some mucosa-associated lymphoid tissue lymphoma cases. 11,12 Methods A detailed description of the patients, samples, and methods are available as supplemental Methods (available on the Blood Web site; see the Supplemental Materials link at the top of the online article). An Inside Blood analysis of this article appears at the front of this issue.The online version of this article contains a data supplement....