TY - JOUR
T1 - Persistent hypogammaglobulinemia due to immunoglobulin class switch impairment by peri-transplant rituximab therapy
AU - Mizuhara, Kentaro
AU - Fujii, Nobuharu
AU - Meguri, Yusuke
AU - Takahashi, Takahide
AU - Aoe, Michinori
AU - Nakamura, Makoto
AU - Seike, Keisuke
AU - Sando, Yasuhisa
AU - Fujii, Keiko
AU - Abe, Masaya
AU - Sumii, Yuichi
AU - Urata, Tomohiro
AU - Fujiwara, Yuki
AU - Saeki, Kyosuke
AU - Asada, Noboru
AU - Ennishi, Daisuke
AU - Nishimori, Hisakazu
AU - Matsuoka, Ken ichi
AU - Maeda, Yoshinobu
N1 - Funding Information:
The authors would like to express their appreciation for the contributions of all the doctors and nurses at Okayama University Hospital. The authors would like to thank Enago (www.enago.jp ) for the English language review.
Publisher Copyright:
© 2020, Japanese Society of Hematology.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Post-transplant lymphoproliferative disorder (PTLD) is one of the most serious complications of allogeneic hematopoietic stem cell transplantation (HSCT). Rituximab is effective for PTLD; however, rituximab can produce adverse effects, including hypogammaglobulinemia. Here, we present the case of an 18-year-old female with refractory cytopenia of childhood who developed persistent selective hypogammaglobulinemia with low immunoglobulin G (IgG) 2 and IgG4 levels and monoclonal protein after rituximab therapy against probable PTLD. Despite B-cell recovery, the serum IgG levels gradually declined, reaching < 300 mg/dL at 33 months after rituximab treatment. In addition, class-switched memory (CD27 +IgD −) B cells were limited in phenotypic analysis. These findings suggest that peri-HSCT rituximab may contribute to an abnormal B-cell repertoire induced by impaired immunoglobulin class switch.
AB - Post-transplant lymphoproliferative disorder (PTLD) is one of the most serious complications of allogeneic hematopoietic stem cell transplantation (HSCT). Rituximab is effective for PTLD; however, rituximab can produce adverse effects, including hypogammaglobulinemia. Here, we present the case of an 18-year-old female with refractory cytopenia of childhood who developed persistent selective hypogammaglobulinemia with low immunoglobulin G (IgG) 2 and IgG4 levels and monoclonal protein after rituximab therapy against probable PTLD. Despite B-cell recovery, the serum IgG levels gradually declined, reaching < 300 mg/dL at 33 months after rituximab treatment. In addition, class-switched memory (CD27 +IgD −) B cells were limited in phenotypic analysis. These findings suggest that peri-HSCT rituximab may contribute to an abnormal B-cell repertoire induced by impaired immunoglobulin class switch.
KW - Allogeneic hematopoietic stem cell transplantation
KW - Hypogammaglobulinemia
KW - Monoclonal protein
KW - Post-transplant lymphoproliferative disorder
KW - Rituximab
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U2 - 10.1007/s12185-020-02886-x
DO - 10.1007/s12185-020-02886-x
M3 - Article
C2 - 32342335
AN - SCOPUS:85084143561
SN - 0925-5710
VL - 112
SP - 422
EP - 426
JO - International Journal of Hematology
JF - International Journal of Hematology
IS - 3
ER -