This month, Arnold S. Freedman, MD, answers a question about restarting rituximab as part of a new chemotherapy regimen for a patient with diffuse large B-cell lymphoma.
In 2012, I treated a young man with follicular lymphoma with four cycles of bendamustine/rituximab. He developed prolonged neutropenia (presumed rituximab associated) that lasted eight months. He now has diffuse large B-cell lymphoma (DLBCL). Would you restart rituximab as part of a new chemotherapy regimen? Is he at higher risk for recurrence of rituximab-associated neutropenia?
Experts Make the Call
Arnold S. Freedman, MD: I would suspect that bendamustine is more likely the cause of the neutropenia. I would perform a bone marrow biopsy and send for cytogenetics. I think you have to use R-CHOP at this time for the DLBCL. IV IgG anecdotally helps reverse the neutropenia of rituximab.
Saikia TK, Menon H, Advani SH. Prolonged neutropenia following anti CD20 therapy in a patient with relapsed follicular non-Hodgkin’s lymphoma and corrected with IVIG. Ann Oncol. 2001 Oct;12:1493-4.
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