Persistent B Cell Depletion After Rituximab for Autoimmune and Glomerular Diseases: A Case Series

Area of Science:

• Immunology
• Rheumatology
• Nephrology

Background:

• Rituximab is a monoclonal antibody used to treat various autoimmune and hematologic conditions.
• Persistent B cell depletion is a rare, poorly understood complication of rituximab therapy.

Purpose of the Study:

• To investigate the clinical implications and characteristics of persistent B cell depletion following rituximab treatment in patients with glomerular and autoimmune diseases.

Main Methods:

• A retrospective case series of 1519 patients treated with rituximab.
• Identified patients with persistent B cell depletion (< 5 CD19+CD20+ cells/μl for > 2 years).
• Analyzed patient demographics, prior treatments, disease outcomes, and complications.

Main Results:

• 2% (30/1519) of patients developed persistent B cell depletion, particularly those with ANCA-associated vasculitis.
• Only 30% of patients showed B cell repopulation within 4 years, with very low counts.
• Sustained disease remission was observed in 83%, but 47% experienced recurrent infections and 57% severe infections.

Conclusions:

• Persistent B cell depletion is a rare rituximab complication, often seen in patients with prior cytotoxic therapy exposure.
• This condition is associated with prolonged disease remission but significantly increases the risk of infections.
• Mortality was observed, primarily due to complications of underlying chronic diseases.