A Retrospective Analysis of Rituximab Treatment for B Cell Depletion in Different Pediatric Indications

Background: Rituximab (RTX) is used in cancer therapy as well as in the treatment of autoimmune diseases and alloimmune responses after transplantation. It depletes the disease-causing B cells by binding to the CD (cluster of differentiation) 20 antigen. We evaluate different pediatric treatment pro...

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Autores principales:	Merlin Wennmann, Simone Kathemann, Kristina Kampmann, Sinja Ohlsson, Anja Büscher, Dirk Holzinger, Adela Della Marina, Elke Lainka
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	rituximab B cell depletion hypogammaglobulinaemia immunodeficiency antibody pediatric Pediatrics RJ1-570
Acceso en línea:	https://doaj.org/article/dd74fc123dc04d76b105e2bc382a3604
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spelling	oai:doaj.org-article:dd74fc123dc04d76b105e2bc382a36042021-12-01T18:30:57ZA Retrospective Analysis of Rituximab Treatment for B Cell Depletion in Different Pediatric Indications2296-236010.3389/fped.2021.651323https://doaj.org/article/dd74fc123dc04d76b105e2bc382a36042021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fped.2021.651323/fullhttps://doaj.org/toc/2296-2360Background: Rituximab (RTX) is used in cancer therapy as well as in the treatment of autoimmune diseases and alloimmune responses after transplantation. It depletes the disease-causing B cells by binding to the CD (cluster of differentiation) 20 antigen. We evaluate different pediatric treatment protocols (via fixed treatment schedule, B cell- or symptom-controlled) and their therapeutic effects.Methods: Demographic information, clinical and laboratory characteristics, and special laboratory values such as immunoglobulin G (IgG), CD19 positive B cells and Epstein-Barr viral load were retrospectively analyzed in children treated with RTX between 2008 and 2016.Results: Seventy-six patients aged 1 to 19 (median 13) years were treated with 259 RTX infusions. The spectrum of diseases was very heterogeneous. RTX led to a complete depletion of the B cells. The reconstitution time varied between patients and was dependent on the application schedule (median 11.8 months). Fourteen out of 27 (52%) patients developed hypogammaglobulinaemia. The risk of IgG deficiency was 2.6 times higher in children under 4 years of age than in olderones. In the last group IgG deficiency developed in only 38% of the cases (n = 8). Recurrent and severe infections were observed each in 11/72 (15%) patients. Treatment-related reactions occurred in 24/76 (32%) cases; however, treatment had to be discontinued in only 1 case. In 16/25 (76%), the Epstein-Barr viral load dropped below the detection limit after the first RTX infusion.Conclusion: RTX is an effective and well-tolerated drug for the treatment of oncological diseases as well as autoimmune and alloimmune conditions in children. B cell depletion and reconstitution varies both intra- und interindividually, suggesting that symptom-oriented and B cell-controlled therapy may be favorable. Treatment-related reactions, IgG deficiency and infections must be taken into account.Merlin WennmannSimone KathemannKristina KampmannSinja OhlssonAnja BüscherDirk HolzingerAdela Della MarinaElke LainkaFrontiers Media S.A.articlerituximabB cell depletionhypogammaglobulinaemiaimmunodeficiencyantibodypediatricPediatricsRJ1-570ENFrontiers in Pediatrics, Vol 9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	rituximab B cell depletion hypogammaglobulinaemia immunodeficiency antibody pediatric Pediatrics RJ1-570
spellingShingle	rituximab B cell depletion hypogammaglobulinaemia immunodeficiency antibody pediatric Pediatrics RJ1-570 Merlin Wennmann Simone Kathemann Kristina Kampmann Sinja Ohlsson Anja Büscher Dirk Holzinger Adela Della Marina Elke Lainka A Retrospective Analysis of Rituximab Treatment for B Cell Depletion in Different Pediatric Indications
description	Background: Rituximab (RTX) is used in cancer therapy as well as in the treatment of autoimmune diseases and alloimmune responses after transplantation. It depletes the disease-causing B cells by binding to the CD (cluster of differentiation) 20 antigen. We evaluate different pediatric treatment protocols (via fixed treatment schedule, B cell- or symptom-controlled) and their therapeutic effects.Methods: Demographic information, clinical and laboratory characteristics, and special laboratory values such as immunoglobulin G (IgG), CD19 positive B cells and Epstein-Barr viral load were retrospectively analyzed in children treated with RTX between 2008 and 2016.Results: Seventy-six patients aged 1 to 19 (median 13) years were treated with 259 RTX infusions. The spectrum of diseases was very heterogeneous. RTX led to a complete depletion of the B cells. The reconstitution time varied between patients and was dependent on the application schedule (median 11.8 months). Fourteen out of 27 (52%) patients developed hypogammaglobulinaemia. The risk of IgG deficiency was 2.6 times higher in children under 4 years of age than in olderones. In the last group IgG deficiency developed in only 38% of the cases (n = 8). Recurrent and severe infections were observed each in 11/72 (15%) patients. Treatment-related reactions occurred in 24/76 (32%) cases; however, treatment had to be discontinued in only 1 case. In 16/25 (76%), the Epstein-Barr viral load dropped below the detection limit after the first RTX infusion.Conclusion: RTX is an effective and well-tolerated drug for the treatment of oncological diseases as well as autoimmune and alloimmune conditions in children. B cell depletion and reconstitution varies both intra- und interindividually, suggesting that symptom-oriented and B cell-controlled therapy may be favorable. Treatment-related reactions, IgG deficiency and infections must be taken into account.
format	article
author	Merlin Wennmann Simone Kathemann Kristina Kampmann Sinja Ohlsson Anja Büscher Dirk Holzinger Adela Della Marina Elke Lainka
author_facet	Merlin Wennmann Simone Kathemann Kristina Kampmann Sinja Ohlsson Anja Büscher Dirk Holzinger Adela Della Marina Elke Lainka
author_sort	Merlin Wennmann
title	A Retrospective Analysis of Rituximab Treatment for B Cell Depletion in Different Pediatric Indications
title_short	A Retrospective Analysis of Rituximab Treatment for B Cell Depletion in Different Pediatric Indications
title_full	A Retrospective Analysis of Rituximab Treatment for B Cell Depletion in Different Pediatric Indications
title_fullStr	A Retrospective Analysis of Rituximab Treatment for B Cell Depletion in Different Pediatric Indications
title_full_unstemmed	A Retrospective Analysis of Rituximab Treatment for B Cell Depletion in Different Pediatric Indications
title_sort	retrospective analysis of rituximab treatment for b cell depletion in different pediatric indications
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/dd74fc123dc04d76b105e2bc382a3604
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A Retrospective Analysis of Rituximab Treatment for B Cell Depletion in Different Pediatric Indications

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