[CIS PIDD] recommendations?

[joseph mittel]

Hello,

I am caring for a 3 month old boy who was exposed to rituximab as R-CHOP at
8, 5 and 2 wks prior to delivery due to his mother’s second trimester
diagnosis of non-Hodgkin’s lymphoma.  The patient was born at term and
exclusively formula fed.  He has been healthy, without infections and with
good weight gain.  However, he has persistently absent CD19 cells, IgM and
IgA.  His IgG level is below the age appropriate range (table below).  Other
B cell markers have not been studied yet, but his T and NK cell counts are
normal.  He received HepB immunization at birth and 2 month immunizations
excluding rotavirus without issue.

There are very few case reports of infants exposed to rituximab in utero,
and not all of them have been well studied.  However, absence of neonatal B
cells has been noted in some of these cases.



Questions:

Has anyone had experience with this?  If so, what did you observe?  Do you
have any recommendations?



Lab

Day 1

Day 30

Day 62

CD19+

N/A

0

0

IgM
mg/dL

N/A

0

0

IgA
mg/dL

N/A

0

0

IgG (mg/dL)

656
(636-1606)

352
(251- 906)

166
(206-601)

CD3+/cmm

N/A

3013 (3800-5300)

3373 (3800-5300)

CD4+/cmm

N/A

1879 (1580-4850)

2201 (1580-4850)

CD8+/cmm

N/A

1166 (680-2470)

1207 (680-2470)

CD56 +/cmm

N/A

97 (23-797)

71 (23-797)

Table 1





Thanks,

R. Joseph Mittel

Second Year Allergy Fellow

Rush University

Chicago, IL
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