Comment on: Persistence of circulating T-follicular helper cells after rituximab is associated with relapse of IgG4-related disease.

Abstract

Dear Editor, We read the article by Mancuso et al. [1] with great interest. They reported that the number of circulating follicular helper T (Tfh) cells from patients with IgG4-related disease (IgG4-RD) remained unchanged even after clinical improvement and B cell depletion by rituximab. They also suggested that persisting Tfh might be associated with future relapse of the disease. In line with their observations, we previously reported that the increased number of circulating Tfh cells was not corrected after clinical improvement by glucocorticoid in patients with IgG4-RD [2–4]. Furthermore, we found reactivation of Tfh cells at relapse of the disease [2]. These results suggest that glucocorticoid or B cell targeting therapy such as rituximab is insufficient to suppress the number of Tfh cells and/or their pathogenic function in IgG4-RD. Considering the frequent relapse of the disease and the toxic effects of glucocorticoids, new...