[CIS PIDD] recommendations?

[Boyce, Thomas G., M.D.]

i have seen a couple kids like this.  it took 6-12 months for them to
recover their B cells and immune globulins. they were supported with
IVIG until B cells, IgM, and IgA came up.  They both did fine
clinically.
 
Thomas G. Boyce, MD, MPH 
Pediatric Infectious Diseases and Immunology 
Mayo Clinic 
Rochester, MN 55905 
phone: 507-255-8464 
fax: 507-255-7767 


________________________________

From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of joseph mittel
Sent: Friday, July 20, 2012 3:24 PM
To: pagid at list.clinimmsoc.org
Subject: [CIS PIDD] recommendations?



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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