eISSN: 1644-4124
ISSN: 1426-3912
Central European Journal of Immunology
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3/2012
vol. 37
 
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abstract:

Clinical immunology
A prolonged progressive lymphopenia with hypogammaglobulinemia after FCR treatment of chronic lymphocytic leukemia: case report and literature review

Ewelina Grywalska
,
Agata Surdacka
,
Monika Pieczykolan
,
Elżbieta Starosławska
,
Karolina Olszewska-Bożek
,
Jacek Roliński

(Centr Eur J Immunol 2012; 37 (3): 264-269)
DOI: https://doi.org/10.5114/ceji.2012.30804
Online publish date: 2012/10/27
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The combination of two chemotherapeutic drugs, fludarabine and cyclophosphamide (FC), with the rituximab (RTX) – FCR – in the treatment of chronic lymphocytic leukemia (CLL) is associated with a high complete remission rate. In recent years FCR has become the first-line choice for CLL patients under 65 year of age. Delayed leucopenia has been described in rituximab-treated CLL patients. However among reported cases, the late onset and progressive lymphopenia was not noticed in individuals with CLL.

The present study reports the case of a 53-year-old Caucasian man who developed prolonged progressive lymphopenia after 18 weeks RTX treatment-free period. Irrespective of no drug intake, in 13-week follow up, the amount of B lymphocytes as well as the serum levels of IgG decreased (93.22% and 20% reduction, respectively). Progressive neutropenia with hypogammaglobulinemia has constantly intensified leading to the necessity of gamma globulin supplementation and administration of granulocyte colony-stimulating factor (G-CSF). The present findings suggests that FCR therapy in some individuals may lead to the induction of persistent alteration of the cellular and humoral immunity.
keywords:

chronic lymphocytic leukemia, hypogammaglobulinemia, lymphopenia, neutropenia, rituximab

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