Delayed-onset and long-lasting severe neutropenia due to rituximab

Monoclonal antibody therapy with the anti-CD20 antibody rituximab has already had an enor-mous impact on the treatment of B-cell lymphoma and autoimmune disorders. The treatment is gen-erally safe and well tolerated and exhibits little interaction with conventional chemotherapies. However, there are some special toxicities which were recognised only in the postmarketing period. Background: Rituximab, a monoclonal anti-body, is effective in CD20-positive B-cell lym-phoma and is now widely used either as a single agent or in combination with chemotherapy. The antibody’s toxicity is generally mild and transient. There are reports of protracted neutropenia in pa-tients treated with rituximab. Case report: We report on a patient with Burkitt’s lymphoma treated with the hyper-CVAD chemotherapy regimen combined with rituximab. Four weeks after the five months ’ treatment marked neutropenia and hypogammaglobulin-aemia occurred and persisted for one year. Both laboratory findings were not associated with severe infections in our patient. Conclusions: Delayed-onset neutropenia is a newly recognised toxicity of rituximab treatment which may last up to one year and be complicated by serious infections. Key words: rituximab; mabthera; neutropenia; hypogammaglobulinaemia; Burkitt’s lymphom