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Delayed‐Onset Grade 4 Neutropenia Associated with Rituximab Therapy in a Patient with Lymphoma: Case Report and Literature Review
Author(s) -
Motl Susannah E.,
Baskin Reed C.
Publication year - 2005
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.2005.25.8.1151
Subject(s) - medicine , rituximab , neutropenia , prednisone , lymphoma , bone marrow , pneumonitis , adverse effect , cyclophosphamide , vincristine , surgery , gastroenterology , chemotherapy , lung
A 53‐year‐old man developed delayed‐onset neutropenia 6 weeks after completing first‐line therapy with rituximab, cyclophosphamide, mitoxantrone, vincristine, and prednisone for high‐grade B‐cell lymphoma. Bone marrow biopsy demonstrated hypercellular marrow with normal maturation. He also developed interstitial pneumonitis, an adverse event associated with rituximab use. Infiltrates of T cells were found in the patient's lungs. For the next 6 months, the patient required subcutaneous granulocyte colony‐stimulating factor 300 μg twice/week to maintain a granulocyte count above 1000 cells/mm 3 . He also received oral antibiotics for mouth sores and thrush. Based on the existing evidence, monitoring blood counts for as long as 8 weeks after rituximab therapy may be advisable, although the literature reports that neutropenia can develop up to 1 year after treatment. The development of a registry and uniform testing may help uncover the cause of this delayed‐onset neutropenia.