ABSTRACT
BACKGROUND: Rituximab is associated with low incidence of hypogammaglobulinemia and little morbidity. Our experience with the combination of rituximab + chemotherapy suggested the opposite. PATIENTS AND METHODS: We analyzed our experience with rituximab plus chemotherapy in 97 patients to determine: frequency and type of non-neutropenic infection (NNI); frequency and type of hypogammaglobulinemia; response to gammaglobulin therapy; and factors associated with NNI. RESULTS: We observed 40 episodes of NNI in 19 of 97 (20%) patients. By 3 years, 43% of patients treated with rituximab + chemotherapy were projected to have developed at least one NNI. Of 19 with NNI, 15 had Ig levels studied and all 15 had hypogammaglobulinemia. Most frequently affected Ig were IgG (14 of 15) and IgM (13 of 14). IgA was usually spared (six of 14 cases affected). NNIs observed were 18 bronchitis, 16 sinusitis, four pneumonias, three otitis media, two fevers of unknown origin (FUOs) and three herpes zoster. Hospitalization was required in seven of 19. Ten received gammaglobulin infusions and all responded promptly. Gammaglobulin was given only when NNIs recurred. We examined sex, age, histology, type of rituximab-chemotherapy (fludarabine + rituximab versus other chemotherapy + rituximab) for correlation with NNI. CONCLUSIONS: Indolent histology, female sex and fludarabine + rituximab significantly correlated with frequency of NNI but multivariate analysis picked fludarabine + rituximab followed by female gender as the only two independent variables predictive of NNI.
Subject(s)
Agammaglobulinemia/chemically induced , Agammaglobulinemia/complications , Antibodies, Monoclonal/adverse effects , Bacterial Infections/etiology , Vidarabine/analogs & derivatives , Adult , Agammaglobulinemia/epidemiology , Aged , Aged, 80 and over , Antibodies, Monoclonal, Murine-Derived , Antineoplastic Agents/adverse effects , Bacterial Infections/epidemiology , Causality , Female , Humans , Incidence , Male , Middle Aged , Retrospective Studies , Rituximab , Vidarabine/adverse effectsABSTRACT
OBJECTIVE: To determine primary and secondary antibody responses in children with hypogammaglobulinemia attributed to corticosteroid use. RESULTS: In seven patients with steroid-dependent asthma and significant hypogammaglobulinemia (IgG concentration, 275 to 443 mg/dl), antibody responses to protein and polysaccharide antigens were shown to be normal, as were primary and secondary responses to a neoantigen, bacteriophage phi X174. CONCLUSIONS: Patients with asthma, and with hypogammaglobulinemia resulting from steroid therapy, have normal humoral immunity, and immunoglobulin replacement therapy is not indicated.
Subject(s)
Agammaglobulinemia/immunology , Anti-Asthmatic Agents/administration & dosage , Asthma/immunology , Prednisone/administration & dosage , Adolescent , Agammaglobulinemia/chemically induced , Anti-Asthmatic Agents/adverse effects , Antibody Formation/drug effects , Asthma/drug therapy , Bacterial Vaccines/immunology , Bacteriophage phi X 174/immunology , Child , Child, Preschool , Diphtheria Toxoid/immunology , Diphtheria-Tetanus Vaccine , Haemophilus Vaccines/immunology , Humans , Immunization/methods , Immunoglobulin A/blood , Immunoglobulin A/drug effects , Immunoglobulin G/blood , Immunoglobulin G/drug effects , Immunoglobulin M/blood , Immunoglobulin M/drug effects , Prednisone/adverse effects , Streptococcus pneumoniae/immunology , Tetanus Toxoid/immunology , Vaccines, Combined/immunologyABSTRACT
The evaluation of immunological conditions of 14 workers occupationally exposed to lead and the comparison of these results with those of a non-exposed control group with similar age and sex were the aims of this study. It was determined the mean values of lead in blood. In exposed workers it was 46.9 micrograms/dl while in the control group it was 10.9 micrograms/dl. Levels of immunoglobulin decreasing while increasing lead concentration in blood were found in those exposed. It was also found a significant decrease in the formation for rosette in relation to the control group.