Secondary rituximab-associated versus primary immunodeficiencies: The enigmatic border

Area of Science:

• Immunology
• Pharmacology
• Genetics

Background:

• Rituximab (RTX) targets CD20-positive cells for immune-related disorders.
• RTX treatment typically allows B-cell reconstitution within months.
• Prolonged B-cell deficiency and hypogammaglobulinemia post-RTX have emerged.

Purpose of the Study:

• To review evidence on post-RTX hypogammaglobulinemia.
• To provide a guideline for identifying high-risk patients.
• To highlight potential inborn errors of immunity.

Main Methods:

• Literature review of studies on RTX and hypogammaglobulinemia.
• Analysis of clinical and immunological manifestations.
• Development of risk stratification criteria.

Main Results:

• Increased incidence of hypogammaglobulinemia reported, especially in children.
• Atypical presentations suggest underlying primary immune deficiencies.
• Identifying RTX-associated hypogammaglobulinemia aids in diagnosing inborn errors of immunity.

Conclusions:

• Post-RTX hypogammaglobulinemia requires careful monitoring.
• Risk stratification can identify patients needing specialized immunology follow-up.
• RTX may unmask genetic immunological disorders.