Селективный дефицит иммуноглобулина А в отдаленном периоде после терапии ритуксимабом

Abstract

Objective of the Paper: To demonstrate the possibility of developing late-onset hypoimmunoglobulinemia after a course of immunosuppressive therapy. Key points. A clinical observation is presented when a selective immunoglobulin A deficiency gradually developed in a patient with Sjögren's disease and MALT-lymphoma, who received rituximab for several years. It was associated with increased frequency of acute respiratory infections. The molecular mechanisms of secondary antibody deficiencies followed by immunisupressive therapy are virtually unknown and are likely to be heterogenous. It is necessary to carry out a differential diagnosis with primary immunodeficiencies. Conclusion. This clinical observation confirms that when choosing rituximab or other anti-B-cell drugs as basic therapy, one should be aware of the possible development of hypoimmunoglobulinemia both during treatment and in the long-term period. Before starting treatment with rituximab, one must determine the initial levels of serum immunoglobulins to assess the risk of infectious complications and identify primary immunodeficiencies and monitor them even after discontinuation of the drug, particularly in patients with infections. Keywords: rituximab, antibody deficiency, immunoglobulin A, Sjogren’s syndrome, lymphoma.