Abstract
Rituximab is associated with late-onset neutropenia, which occurs after the end of therapy. This side effect was initially considered a rare phenomenon, but recent studies have suggested an incidence rate between 5 and 30%. Although its physiopathology is poorly understood, recent advances have suggested that production of large granular lymphocytes and/or disruption of B-cell homeostasis during B-cell recovery after rituximab therapy could explain the occurrence of neutropenia. This complication is not usually associated with life-threatening complications, and treatment is based on antibiotics and G-CSF, if indicated. Retreatment after the first episode of neutropenia is probably associated with an increased risk of relapse. Besides this complication, the use of rituximab alone or with chemotherapy is associated with an increased risk of neutropenia and infection during treatment. These infectious complications are usually benign, mostly within the ORL and bronchus tract.
Résumé
Le rituximab est associé à un risque de neutropénie tardive, survenant en moyenne dans les six mois qui suivent l’arrêt du traitement. Cet effet secondaire, largement sous-déclaré, pourrait concerner jusqu’à un tiers des patients traités. La physiopathologie est mal connue et impliquerait essentiellement l’expansion de grands lymphocytes à grains et/ou un déséquilibre au moment de la reconstitution lymphocytaire B induite par le traitement. Alors que le risque de complication grave est limité, la prise en charge comporte une antibiothérapie en cas de fièvre, éventuellement associée à des facteurs de croissance. Le retraitement par rituximab pourrait être associé à un risque plus important de complication. À côté de cet effet, le rituximab, seul ou en association avec la chimiothérapie, semble augmenter, pendant le traitement, le risque de neutropénie et le risque infectieux. Celui-ci reste cependant le plus souvent limité à des complications ORL ou bronchiques de gravité faible.
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Delarue, R. Neutropénie et risque infectieux sous rituximab. Oncologie 13, 581–584 (2011). https://doi.org/10.1007/s10269-011-2068-y
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DOI: https://doi.org/10.1007/s10269-011-2068-y