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Thread: Rituximab associated hypogammaglobulinemia:

  1. #1
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    Default Rituximab associated hypogammaglobulinemia:

    For those patients on Rituximab it is very important to stay on top of your B Cell numbers post infusion. My experience has been that a lot of doctors don't take into consideration the long term affects that Rituximab can have on our immune systems. I have linked below a study published by the NIH that addresses this. If your body stops producing B Cells you are very susceptible to infections as your B Cells are needed to create antibodies. For those whom have been vaccinated I would advise that you get a T-B Cell screen done along with a COVID antibody test to see if the vaccine was effective for you otherwise you may be living with a false sense of security. We need to educate ourselves and be our own advocates.

    Abstract

    Rituximab is a B cell depleting monoclonal antibody used to treat lymphoma and autoimmune disease. Hypogammaglobulinemia has occurred after rituximab for lymphoma and rheumatoid arthritis but data are scarce for other autoimmune indications. This study describes the incidence and severity of hypogammaglobulinemia in patients receiving rituximab for small vessel vasculitis and other multi-system autoimmune diseases. Predictors for and clinical outcomes of hypogammaglobulinemia were explored. We conducted a retrospective study in a tertiary referral specialist clinic. The severity of hypogammaglobulinemia was categorized by the nadir serum IgG concentration measured during clinical care. We identified 288 patients who received rituximab; 243 were eligible for inclusion with median follow up of 42 months. 26% were IgG hypogammaglobulinemic at the time that rituximab was initiated and 56% had IgG hypogammaglobulinemia during follow-up (5-6.9 g/L in 30%, 3-4.9 g/L in 22% and <3 g/L in 4%); IgM ≤0.3 g/L in 58%. The nadir IgG was non-sustained in 50% of cases with moderate/severe hypogammaglobulinemia. A weak association was noted between prior cyclophosphamide exposure and nadir IgG concentration, but not cumulative rituximab dose. IgG concentrations prior to and at the time of rituximab correlated with the nadir IgG post rituximab. IgG replacement was initiated because of recurrent infection in 12 (4.2%) patients and a lower IgG increased the odds ratio of receiving IgG replacement. Rituximab is associated with an increased risk of hypogammaglobulinemia but recovery of IgG level can occur. IgG monitoring may be useful for patients receiving rituximab.

    Keywords: ANCA; Autoimmune; Hypogammaglobulinemia; Infection; Rituximab; Vasculitis.

    Crown Copyright 2014. Published by Elsevier Ltd. All rights reserved.

    https://pubmed.ncbi.nlm.nih.gov/25556904/
    Last edited by gunnyl; 04-21-2021 at 11:18 PM.

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  3. #2
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    Default Re: Rituximab associated hypogammaglobulinemia:

    Thanks for the important info.

    My Igg and Igm have dropped below the normal so for now I am not allowed to get rtx. My dr prescribed me Leflunomide, which works well for me, although my wg is smoldering. But it was smoldering also between rtx treatments.
    I do have throat infections all the time. I guess it is because of the low immunity.

    I am still careful considering covid, eventhough I got the vaccin.

    My wg dr said that if I will flare I will have to get Ivig first and only after my Igg abd Igm will be normal, I will be able to get rtx.
    Alysia
    dx 2008


    Here, in this forum, I have found my sweet eternal love, my beautiful Phil.. :
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    "You are my sunshine", he used to sing to me... "you make me happy, when skies are grey" I still answer him.
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  5. #3
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    Default Re: Rituximab associated hypogammaglobulinemia:

    So, I got my results and I generated zero antibodies to the SARS-CoV-2 virus after getting both vaccines and a couple of weeks waiting.
    If you're vaccinated, it would be worth the expense to get tested and know if it was effective in your case.
    Unfortunately in mine it was not. Don't live with a false sense of security.

    Sent from my HD1907 using Tapatalk

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