[CIS PIDD] recommendations?

[Mary Kay Tobin]

Joseph,
Thanks for putting out this question to the PID community!

Mary C. Tobin MD


On Jul 20, 2012, at 3:23 PM, joseph mittel <joseph.mittel at gmail.com> wrote:


> 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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