Studies describing prevalence of hypogammaglobulinemia secondary to rituximab and infections in patients with NMHDs
| Study . | Population . | N . | Definition of hypoG (IgG) . | Prevalence of hypogG . | Follow-up period . | Prevalence of infection . | Comments . |
|---|---|---|---|---|---|---|---|
| Rao et al, 200911 | ITP, AIHA among adult and pediatric patients with ALPS | 12 | 3 (25%) of 12 | 8 y | All were treated with IVIg; 1 additional patient had total absence of antibody response to polysaccharide vaccines for 4 years; 10 of 12 patients were age 18 years or younger | ||
| Levy et al, 20148 | ITP, adult and pediatric patients | 189 | <500 mg/dL | 3 (1.6%) of 189 | 12 y | 3 of 3 patients had recurrent severe infections | 2 of 3 patients were later diagnosed with CVID |
| 192* | 21 of 192* | 16 (50%) of 32 of studies had >1 y of follow-up | 5 of 192* patients had frequent minor infections | IgG levels, when tested, were normal before initiation of rituximab; 1 of 21 patients with hypoG was later diagnosed with CVID | |||
| Reboursiere et al, 20169 | ITP, mostly adult patients (2 patients younger than age 18 years) | 35 | <800 mg/dL; severe, <500 mg/dL | 8 (44%) of 18; 1 severe | Median, 47 mo | No patients were known to have hypoG; 2 of 35 had pneumonia; | 3 patients had hypoG before initiation of rituximab and hypoG remained after treatment but did not become severe; 1 patient developed severe hypoG and had normal pre-treatment levels of IgG |
| 1 of 35 had recurrent herpes | |||||||
| Barmettler et al, 20181 | Hematologic disorder, adult patients | 340 | <600 mg/dL; mild: 400-599 mg/dL; moderate: 200-399 mg/dL; severe: <199 mg/dL | 26 (7.6%) of 340; moderate or severe | 18 mo | Infection rate in the 6 months before rituximab was 24.1% and after rituximab, it was 23.8% (P = .98) | 33 (9.7%) of 340 patients received IgRT after treatment with rituximab |
| Deshayes et al, 201910 | ITP, adult patients | 248 | <500 mg/dL | 5 (3.5%) of 142 | 5 y | 59 (23.8%) of 248 patients; 21 (8.5%) had severe infection | 142 (57%) of 248 patients had IgG levels; 1 patient with known hypoG developed infection |
| Ottaviano et al, 202012 | ITP, AIHA, ES; pediatric patients only, exclusion criteria was preexisting PID | 53 | IgG <2 SD for age | 17 (32%) of 53 | Mean, 30 mo | 7 (12%) of 53 patients had infections requiring hospitalization; | 9 (17%) of 53 patients were later diagnosed with PID |
| 8 (15%) of 53 had recurrent respiratory infections |
| Study . | Population . | N . | Definition of hypoG (IgG) . | Prevalence of hypogG . | Follow-up period . | Prevalence of infection . | Comments . |
|---|---|---|---|---|---|---|---|
| Rao et al, 200911 | ITP, AIHA among adult and pediatric patients with ALPS | 12 | 3 (25%) of 12 | 8 y | All were treated with IVIg; 1 additional patient had total absence of antibody response to polysaccharide vaccines for 4 years; 10 of 12 patients were age 18 years or younger | ||
| Levy et al, 20148 | ITP, adult and pediatric patients | 189 | <500 mg/dL | 3 (1.6%) of 189 | 12 y | 3 of 3 patients had recurrent severe infections | 2 of 3 patients were later diagnosed with CVID |
| 192* | 21 of 192* | 16 (50%) of 32 of studies had >1 y of follow-up | 5 of 192* patients had frequent minor infections | IgG levels, when tested, were normal before initiation of rituximab; 1 of 21 patients with hypoG was later diagnosed with CVID | |||
| Reboursiere et al, 20169 | ITP, mostly adult patients (2 patients younger than age 18 years) | 35 | <800 mg/dL; severe, <500 mg/dL | 8 (44%) of 18; 1 severe | Median, 47 mo | No patients were known to have hypoG; 2 of 35 had pneumonia; | 3 patients had hypoG before initiation of rituximab and hypoG remained after treatment but did not become severe; 1 patient developed severe hypoG and had normal pre-treatment levels of IgG |
| 1 of 35 had recurrent herpes | |||||||
| Barmettler et al, 20181 | Hematologic disorder, adult patients | 340 | <600 mg/dL; mild: 400-599 mg/dL; moderate: 200-399 mg/dL; severe: <199 mg/dL | 26 (7.6%) of 340; moderate or severe | 18 mo | Infection rate in the 6 months before rituximab was 24.1% and after rituximab, it was 23.8% (P = .98) | 33 (9.7%) of 340 patients received IgRT after treatment with rituximab |
| Deshayes et al, 201910 | ITP, adult patients | 248 | <500 mg/dL | 5 (3.5%) of 142 | 5 y | 59 (23.8%) of 248 patients; 21 (8.5%) had severe infection | 142 (57%) of 248 patients had IgG levels; 1 patient with known hypoG developed infection |
| Ottaviano et al, 202012 | ITP, AIHA, ES; pediatric patients only, exclusion criteria was preexisting PID | 53 | IgG <2 SD for age | 17 (32%) of 53 | Mean, 30 mo | 7 (12%) of 53 patients had infections requiring hospitalization; | 9 (17%) of 53 patients were later diagnosed with PID |
| 8 (15%) of 53 had recurrent respiratory infections |
ALPS, autoimmune lymphoproliferative syndrome; CVID, common variable immune deficiency; hypoG: hypogammaglobulinemia; IVIg, intravenous Ig; SD, standard deviation.
Pooled numbers from systematic review.