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Persistent hypogammaglobulinemia due to immunoglobulin class switch impairment by peri-transplant rituximab therapy

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Abstract

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.

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Acknowledgements

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.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan

    Kentaro Mizuhara, Nobuharu Fujii, Yusuke Meguri, Makoto Nakamura, Keisuke Seike, Yasuhisa Sando, Keiko Fujii, Masaya Abe, Yuichi Sumii, Tomohiro Urata, Yuki Fujiwara, Kyosuke Saeki, Noboru Asada, Daisuke Ennishi, Hisakazu Nishimori, Ken-ichi Matsuoka & Yoshinobu Maeda

  2. Department of Transfusion Medicine, Okayama University Hospital, Okayama, Japan

    Nobuharu Fujii, Makoto Nakamura, Keisuke Seike, Yasuhisa Sando & Keiko Fujii

  3. Department of Laboratory Medicine, Okayama University Hospital, Okayama, Japan

    Takahide Takahashi & Michinori Aoe

Authors
  1. Kentaro Mizuhara
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  2. Nobuharu Fujii
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  3. Yusuke Meguri
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  4. Takahide Takahashi
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  5. Michinori Aoe
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  7. Keisuke Seike
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  8. Yasuhisa Sando
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  9. Keiko Fujii
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  10. Masaya Abe
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  11. Yuichi Sumii
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  12. Tomohiro Urata
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  13. Yuki Fujiwara
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  14. Kyosuke Saeki
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  15. Noboru Asada
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  16. Daisuke Ennishi
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  17. Hisakazu Nishimori
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  18. Ken-ichi Matsuoka
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  19. Yoshinobu Maeda
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Corresponding author

Correspondence to Nobuharu Fujii.

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Mizuhara, K., Fujii, N., Meguri, Y. et al. Persistent hypogammaglobulinemia due to immunoglobulin class switch impairment by peri-transplant rituximab therapy. Int J Hematol 112, 422–426 (2020). https://doi.org/10.1007/s12185-020-02886-x

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  • DOI: https://doi.org/10.1007/s12185-020-02886-x

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