The efficacy and safety of rituximab pre-treatment in allogeneic hematopoietic stem cell transplantation in pediatric patients with severe aplastic anemia.

Rethinking rituximab in neuroimmunology: Real-world efficacy, cost-effectiveness, and long-term remission.

Rituximab (RTX) is effective first-line therapy for primary membranous nephropathy (PMN), but some patients respond poorly or develop anti-rituximab antibodies (ARA), leading to treatment failure. Obinutuzumab (OBZ), a humanized anti-CD20 monoclonal antibody, shows therapeutic potential in these patients. However, the emergence and clinical relevance of anti-obinutuzumab antibodies (AOA) remain unclear. We aimed to evaluate the role of AOA in PMN patients. We retrospectively analyzed 23 PMN patients treated with OBZ, including 7 AOA-positive cases. Baseline characteristics, immunological and clinical remission outcomes were compared between AOA-positive and AOA-negative groups. Associations between AOA status, titer, cumulative exposure, and time to remission were assessed. AOA developed in 7 patients (30.4%), exclusively after≥3 months of therapy (median seroconversion: 12.4 months [8.7-13.6]). AOA-positive patients were more frequently male (100%vs. 56.3%, P = 0.036), had higher baseline serum albumin (30.4 ± 6.2vs. 24.4 ± 6.0g/L, P = 0.04), and were more likely ARA-positive (85.7%vs. 18.8%, P = 0.005). No differences were observed in eGFR, UPCR, anti-PLA2R titers, or CD19⁺ B-cell counts at baseline. Immunological remission rates were comparable (100%vs. 92.3%, P = 0.452); clinical remission was achieved in 85.7%vs. 60.0% (P = 0.228). Kaplan-Meier analysis showed no significant difference in time to clinical (P = 0.48) or immunological remission (P = 0.21). Among AOA-positive patients, higher baseline AOA titer (Spearman r = 0.829, P = 0.042) and greater cumulative AOA exposure (AUC; r = 0.943, P = 0.017) strongly correlated with delayed clinical remission. 30.4% of PMN patients with OBZ therapy were tested positive for AOA. Although no statistically significant association was observed between AOA status and treatment outcomes, higher AOA titers and greater cumulative exposure were associated with slower clinical remission, suggesting a modulatory effect on OBZ efficacy in our PMN cohort.

ABSTRACTBackgroundB‐cell–depleting anti‐CD20 therapies are among the most effective disease‐modifying treatments for relapsing–remitting multiple sclerosis (RRMS). Rituximab (RTX) is widely used off‐label, while ocrelizumab (OCR) is approved for RRMS; yet comparative real‐world evidence between the two remains limited.MethodsWe conducted a retrospective registry‐based cohort study using the Finnish MS Registry, including adult RRMS patients treated with RTX or OCR between 2018 and 2024 at two university hospitals. Propensity score matching (1:1) was applied to balance baseline characteristics. Primary outcomes were annualized relapse rate (ARR) during follow‐up and relapse‐free survival. Secondary outcomes included MRI activity, disability progression, adverse events, and longitudinal plasma immunoglobulin G (IgG) levels.ResultsOf 636 screened patients, 191 met inclusion criteria and 112 patients (56 RTX, 56 OCR) were included after matching. Median follow‐up was 3.1 years for RTX and 2.6 years for OCR. ARR was low and similar in both groups (mean 0.03), and relapse‐free survival did not differ (log‐rank p = 0.95; HR 0.95, 95% CI 0.21–4.33). MRI activity remained largely stable, with no significant differences in T2 lesion changes. Adverse events were infrequent and mild. IgG declined modestly in both groups (mean−13%), with values below the reference range in 4.5% of patients and no association with infections. No disease reactivation was observed among patients switching from OCR to RTX.ConclusionsIn this population‐based Finnish real‐world study, RTX and OCR demonstrated comparable effectiveness and safety in RRMS, supporting RTX as a rational alternative to OCR in routine clinical practice.

There are few prospective studies of mycophenolate mofetil (MMF) versus cyclophosphamide (CYC) for pediatric lupus nephritis (pLN) and none evaluating rituximab (RTX). The Prospective Pediatric Lupus Nephritis Registry (ProPeL-R) enrolled patients < 21years within 4weeks of an initial kidney biopsy diagnostic of pLN. Demographic, clinical, and laboratory data were collected prospectively at enrollment, 3months, 6months, and then every 6months thereafter for up to 5years of follow-up. For this study, we compared patients receiving initial therapy with corticosteroids (CS) and either MMF (n = 33) vs. CYC (n = 18), and those treated with CS, either MMF or CYC, with RTX (n = 20) vs. without RTX (n = 51). Histology consisted of 18% class III; 35% class IV; 25% mixed class; and 22% pure class V. Eighty-two percent were female. No significant differences in response or infection rates were identified between those receiving MMF or CYC. There was a significant increase in combined complete (CR) and partial response (PR) at 24months with RTX use. Overall CR rates at 6 and 24months were 35% and 58%, respectively. At 24months, 51% of patients continued on CS, and 56% of patients experienced at least one CS side effect. MMF and CYC had similar efficacy as initial therapies for pLN. RTX may augment long-term response. However, response rates were suboptimal. Large variations in initial therapy were observed. Given the paucity of prospective data in pLN, our study further illustrates the need for data-driven, pediatric-specific protocols to standardize care and improve outcomes.

Primary membranous nephropathy (pMN) is characterized by a prolonged course, frequent relapses, and variable treatment responses. While obinutuzumab (OBI) demonstrates promising efficacy in B-cell depletion, its direct comparison with the combination regimen of rituximab (RTX) plus tacrolimus (TAC) remains limited. This study aimed to evaluate the efficacy and safety of OBI monotherapy versus RTX + TAC in patients with refractory pMN. We retrospectively enrolled 28 patients with biopsy-proven pMN from a single center, assigned to RTX + TAC (n = 13) or OBI (n = 15) groups according to treatment regimen. Clinical remission, immunological remission (IR), and adverse events were assessed over 24 months of follow-up. No significant differences were observed in serum creatinine, estimated glomerular filtration rate (eGFR), serum albumin, urine protein excretion, or anti-phospholipase A2 receptor (PLA2R) antibody titers between the two study groups. In contrast, disease duration differed substantially between groups: the OBI group exhibited a significantly longer median disease duration (87.7 (29, 168) months) compared with the RTX + TAC group (14 (7, 36) months). At the end of follow-up, the cumulative clinical remission rate (achieving complete remission or partial remission) was 89.1% among 11 patients included in the RTX + TAC group, and 92.9% among 14 patients in the OBI group. For IR, the cumulative IR rate was 60.0% among 10 patients in the RTX + TAC group and 90.9% among 11 patients in the OBI group. Kaplan-Meier survival analysis further demonstrated a statistically significant difference in cumulative IR rates between the two groups (P = 0.03). OBI monotherapy achieved comparable 24-month clinical remission and safety to RTX + TAC in pMN, but with superior IR rates. These findings support B-cell depletion as a central therapeutic strategy, though long-term clinical benefits require further study.

Efficacy of low-dose rituximab as preemptive treatment of EBV DNA-emia after allogeneic hematopoietic stem cell transplantation.

A real-world study on the long-term efficacy of rituximab in relapsing myelin oligodendrocyte glycoprotein antibody-associated disease.

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV)-granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA)-as well as anti-glomerular basement membrane disease (anti-GBM disease) are systemic small-vessel vasculitides with high mortality. Diagnosis relies on serology/laboratory testing, organ screening, and exclusion of differential diagnoses. Biopsy must not delay therapy initiation in fulminant cases. In GPA and MPA, loss of T‑ and B‑cell tolerance and ANCA-mediated activation of neutrophils are pivotal. Diagnostic hallmarks include myeloperoxidase (MPO)- or proteinase 3 (PR3)-ANCA. Kidney biopsy reveals pauci-immune necrotizing and extracapillary proliferative glomerulonephritis. Remission induction consists of glucocorticoids (GC) combined with rituximab (RTX) or cyclophosphamide (CYC). Maintenance therapy is preferably performed with RTX. EGPA is defined by eosinophilic tissue infiltration, often accompanied by asthma and nasal polyposis; ANCAs are present in 30-40%. Diagnostic evaluation includes blood count, inflammatory markers, immunoglobuline E (IgE), ANCA, and ENT, pulmonary, and cardiac evaluation. Nonorgan-threatening disease is treated with GC, whereas relapsing disease is managed with interleukin (IL)-5 pathway inhibitors. Organ- or life-threatening manifestations require GC plus CYC or RTX, followed by IL‑5 pathway inhibitors for maintenance therapy. Anti-GBM is driven by autoantibodies against typeIV collagen and presents with anephritic syndrome and/or alveolar hemorrhage. Within 24 h, diagnostic evaluation should include testing for anti-GBM antibodies and ANCA, thoracic imaging, exclusion of infection, and akidney biopsy demonstrating linear IgG deposits. Treatment consists of plasmapheresis combined with GC and CYC, with RTX as an alternative. Maintenance therapy is not required unless concomitant ANCA positivity is present.

Aquaporin 4 (AQP4) neuromyelitis optica spectrum disorder (NMOSD) is a demyelinating disorder of the central nervous system. Following an acute attack, morbidity is incapacitating, and long-term immunotherapy is the rule. This study assesses the clinical profile, annualized relapse rate (ARR), effectiveness, and adverse effects of long-term immunosuppression in Indian patients with AQP4+NMOSD. This is an ambispective observational study of AQP4+NMOSD patients diagnosed in Nizam's Institute of Medical Sciences, Hyderabad, India, over 10 years between January 2010 and December 2019. Clinical and demographic data and details of immunosuppressive drugs were noted. Our study had 52 patients. Forty-six (87%) were female. The mean age of patients was 31.82 years. The mean expanded disability status scale at the time of onset of the disease and last follow-up was 6.63 and 3, respectively. The median pretreatment ARRs of the patients before initiation of long-term immunosuppression for methotrexate (MTX), azathioprine (AZA), mycophenolate (MMF), and rituximab (RTX) were 2, 2, 1, and 0.67, respectively. The median post-treatment ARRs of the patients on MTX, AZA, MMF, and RTX at the last follow-up were 0.36, 0.16, 0, and 0, respectively. The relapse-free interval was better with RTX, followed by AZA and MMF, on the Kaplan-Meier curve. This is a single-center study from South India with a long follow-up period, adding to the existing body of literature that is available in the management of NMOSD. In our study, patients on RTX had better outcomes, followed by AZA, MMF, and MTX. The threshold to start RTX can be low in patients with NMOSD.

Antiglomerular basement membrane (anti-GBM) disease is a rare, small-vessel vasculitis because of antibodies targeting the glomerular and alveolar capillaries, leading to rapidly progressive glomerulonephritis and/or pulmonary hemorrhage. Data on children with anti-GBM are scarce. We collected clinical and biochemical data from European pediatric and adult patients diagnosed with anti-GBM disease between 2020 and 2024. A total of 72 patients (35% children) with anti-GBM disease and with a median follow-up of 18 months were analyzed. Pediatric cases were more often female and had higher estimated glomerular filtration rate (eGFR) at the time of diagnosis (each P < 0.01), whereas the percentage of patients requiring dialysis, presence of pulmonary hemorrhage, and immunological findings did not statistically differ between groups. Treatment consisted mainly of daily plasma exchanges (PEXs)and corticosteroids at higher weight-based doses in children (P < 0.0001), in combination with cyclophosphamide (CYC) or, preferably in children (P < 0.05), with rituximab (RTX) and mycophenolate mofetil (MMF). Final eGFR was higher in children than in adults (P < 0.0001), although the frequency of kidney failure did not significantly differ between children (24%) and adults (38%). Adult patients and patients who required dialysis at the time of diagnosis had a 16-fold and 11-fold increased risk of chronic kidney disease (CKD) stage 3 or higher, respectively. Our study indicates that girls predominate among children with anti-GBM disease and that children have a better outcome in terms of eGFR than adults, which is at least partly because of better eGFR values at diagnosis. The need for dialysis is a strong predictor of outcome, regardless of age.

Introduction Immunoglobulin G4-related disease (IgG4RD) is a chronic immune-mediated disease that typically affects organs such as the pancreas, bile ducts, salivary glands, and lymph nodes. Involvement of the lungs was also reported. The disease usually responds well to standard immunosuppressive and glucocorticosteroid (GC) therapy, and, in refractory cases, biologic treatment, as in the case of the presented patient. Case description A 48-year-old patient presented with lymphadenopathy persisting for one year, located in the head, neck, and supraclavicular areas, accompanied by increased sweating and weight loss. Oncological and infectious diseases were investigated, with no identifiable cause of the reported symptoms. A cervical lymph node biopsy revealed: plasma cell density of 150–200 focal cells/HPF, predominant CylgG(+) cells with 40–50% IgG4(+) subclass content, and typical storiform fibrosis pattern. This, along with elevated serum IgG4 concentrations, led to the diagnosis of IgG4-RD disease in October 2023. Treatment with methyl- prednisolone and methotrexate was initiated, but due to the lack of improvement after 2 months, cyclosporine was added (to a maximum dose of 5 mg/kg), without achieving remission. The patient’s clinical condition did not improve; significantly elevated acute-phase markers persisted in the serum. During GC dose reduction, new foci of lymphadenopathy (mainly paraaortic nodes and along the iliac vessels) and fibrotic nodules in the lungs appeared. A verification biopsy of the inguinal lymph node was performed, confirming the diagnosis of IgG4-RD. Due to the ineffectiveness of standard treatment and exhaustion of therapeutic options, rituximab (RTX) therapy was decided upon. Three cycles of RTX were administered: in January and July 2025, and in January 2026. Between cycles of RTX administration, clinical improvement was observed, along with a reduction in the size of the cervical, axillary, inguinal, and abdominal lymph nodes, but with persistent progression of pulmonary lesions (intensification of nodular lesions and atelectasis of the right middle lobe). Conclusions The presented case report illustrates the course of IgG4-RD refractory to standard treatment that poses a clinical challenge. The anti-CD19 antibody, inebilizumab, recently recognised as a breakthrough in the treatment of this disease, may be a new therapeutic proposition for such patients.

Introduction Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease. Shrinking lung syndrome (SLS) is a rare pulmonary complication of SLE and other connective tissue diseases – e.g. Sjögren’s disease, characterised by dyspnea, restrictive ventilatory defect, and diaphragmatic dome elevation, mimicking e.g. infections. Case description In 2022, a 32-year-old man had a severe left-sided pneumonia with pleural abscess, treated with ciprofloxacin and therapeutic video-assisted thoracoscopy, with good clinical response. Pleural fluid cultures were negative, including for Mycobacterium tuberculosis. In June 2024, the patient developed arthritis, myalgia, and progressive exertional dyspnea with elevated inflammatory markers (C-reactive protein: 85 mg/l, erythrocyte sedimentation rate: 50 mm/h), high-titer antinuclear antibodies (ANA 1 : 1,280, homogenous pattern), and borderline proteinuria (0.51 g/24 h). Glucocorticosteroid (GC) therapy (prednisone 0.5 mg/kg/day) led to a transient clinical improvement. The patient was admitted to the Department of Connective Tissue Diseases at the National Institute of Geriatrics, Rheumatology and Rehabilitation in October 2024 for suspected SLE, reporting progressive dyspnea, unintentional weight loss (10 kg in 4 months), and myalgia. Diagnosis of SLE was confirmed based on 2019 American College of Rheumatology/European Alliance of Associations for Rheumatology criteria (23 points): ANA &gt; 1 : 80, arthritis, pleural and pericardial effusion, presence of lupus anticoagulant, proteinuria, and anti-dsDNA antibodies. High disease activity was assessed (SELENA-SLEDAI 12). Due to progressive dyspnea, severe restrictive ventilatory defect (forced vital capacity [FVC]: 28%, total lung capacity [TLC]: 37%), and right pleural effusion with hemidiaphragm elevation, SLS associated with SLE was suspected. The patient received methylprednisolone pulses (in total 5 g i.v.), followed by oral prednisone (40 mg/day) and hydroxychloroquine (400 mg/day). After infection exclusion, treatment with anti-CD20 monoclonal antibody ritux imab (2 × 1,000 mg, 14-day interval, first treatment cycle) and mycophenolate mofetil (p.o. 2 g/day) was initiated in March 2025. This led to a significant clinical improvement (SELENA-SLEDAI 0) and pulmonary recovery (FVC 65%, TLC 58%) by August 2025. In November 2025, GCs were discontinued. Conclusions This case shows that SLE can have atypical organ manifestations, complicating diagnosis. A rare autoimmune rheumatic complication – SLS, should be considered in progressive dyspnea with restrictive lung deficit. Prompt immunosuppressive treatment, including B-cell depleting therapy, can improve lung function and induce remission.

Rituximab (RTX) is widely used as first-line therapy for PLA2R-associated membranous nephropathy (MN), but the optimal timing for assessing response and guiding retreatment remains uncertain, particularly in patients with slow clinical improvement. We report a 46-year-old man with PLA2R-associated MN who showed poor response to high-dose glucocorticoids and was subsequently treated with a low-dose, fractionated RTX regimen (total 3.6g over 14 months).Notably, a significant reduction in proteinuria was not observed until 19 months after treatment initiation, when partial remission (proteinuria < 3.5g/day) was first achieved. During 44 months of follow-up, proteinuria continued to decline and remission was maintained, while anti-PLA2R antibodies remained negative despite gradual reconstitution of circulating CD19⁺ B cells, and no further immunosuppressive therapy was administered.This case demonstrates a markedly delayed but durable clinical response to rituximab and illustrates that B-cell repopulation does not necessarily indicate disease relapse when anti-PLA2R antibodies remain suppressed, supporting the value of antibody-guided rather than B-cell-guided monitoring in slow responders.

Serum neurofilament light chain (sNfL) and glial fibrillary acidic protein (sGFAP) levels are believed to reflect mainly acute and chronic disease processes in multiple sclerosis (MS), respectively. In this study, we investigated whether dimethyl fumarate (DMF) and rituximab (RTX) differentially affect these biomarkers. RIFUND-MS was a 2-year, rater-blinded, 1:1 randomized controlled multicenter trial comparing DMF and RTX in relapsing-remitting multiple sclerosis (RRMS). Serum samples for analysis of sNFL and sGFAP were collected at baseline and 0, 6, 12 and 24. Log-transformed biomarker data were analyzed with linear mixed models, based on intention to treat (ITT), per protocol (PP) and accounting for therapy switches. Cox proportional hazards models were performed to evaluate progression outcomes. Of 200 participants, 197 were analyzed. Based on ITT, sNfL decreased significantly in both arms from baseline to month 24; by 50.7% (CI 43.7%-56.8%; p < 0.001) with RTX, and by 46.4% (CI 38.6%-53.2%; p < 0.001) with DMF, no differences between treatments (global p-value: ITT = 0.06; PP = 0.08; switch group = 0.15). In contrast, sGFAP remained stable in RTX (3.6% decrease; CI -7.8%-13.8%, p = 0.81) but decreased with DMF (18.4%; CI 8.5%-27.2%; p < 0.001). Global analyses favored DMF (ITT = 0.02; PP = 0.004; switch group = 0.74). The risk of progression independent of relapse and MRI activity (PIRMA) was higher with RTX (HR 3.3, CI 1.1-10, p = 0.04). Both RTX and DMF reduced sNfL levels, consistent with suppression of acute inflammatory disease activity. However, only DMF was associated with a sustained reduction in sGFAP and a lower risk of non-inflammatory disability progression. These findings suggest that DMF may exert additional effects on astrocyte-related or compartmentalized CNS pathology beyond peripheral immune modulation.

This retrospective cohort study aimed to evaluate real-world data on the efficacy of rituximab (RTX) alone versus combined rituximab/cyclophosphamide (RTX/CYC) induction therapy, followed by RTX maintenance, compared with cyclophosphamide-azathioprine (CYC-AZA) therapy in ANCA-associated vasculitis (AAV). Patients with new-onset or relapsing organ- or life-threatening AAV (granulomatosis with polyangiitis [GPA] n=97; microscopic polyangiitis [MPA], n=69) were followed over 24-months. Patients with previous RTX and/or CYC therapy were excluded. Treatment comprised combination of GC with either RTX alone or RTX/CYC combination for remission induction, each followed by RTX maintenance therapy, or CYC-AZA therapy. The primary outcome measure was complete remission defined as absence of vasculitis activity with no concomitant GC therapy after 12 and 24 months. 20% and 35% of the patients in the RTX group and 22% and 33% in the RTX/CYC group achieved complete remission at 12 and 24 months, contrasting with 3% and 9% in the CYC-AZA group (p=0.008 and p=0.003, respectively). The majority of patients achieved remission with concomitant GC therapy at any time during the 24-months observation period (RTX, 88%; RTX/CYC, 87%; CYC-AZA, 81%; p=0.097). RTX alone was associated with a lower relapse rate compared with RTX/CYC in the subgroup of GPA patients (p=0.041). Moreover, RTX alone was comparably effective to RTX/CYC and CYC-AZA in terms of relapse in patients with severe renal disease (p=0.091). RTX alone was similarly effective to RTX/CYC combination and CYC-AZA therapy in AAV patients, including those with severe renal involvement.

The efficacy of rituximab plus telitacicept in neuropsychiatric systemic lupus erythematosus: A retrospective study.

Factors Influencing Early and Late B-Cell Repopulation After Rituximab Therapy in Pediatric Central Nervous System Inflammatory Disorders.

This post hoc analysis of the CHAMPION-NMOSD trial evaluated the safety and efficacy of ravulizumab in patients with aquaporin-4 antibody-positive (AQP4-Ab+) neuromyelitis optica spectrum disorder (NMOSD) previously exposed or naïve to rituximab (RTX). Patients received weight-based intravenous ravulizumab with a loading dose followed by maintenance dosing every 8 weeks. Patients were stratified by prior RTX exposure: no RTX exposure (RTX-naïve) vs RTX exposure > 3 months before initiating ravulizumab (RTX-exposed). Key outcomes included treatment-emergent adverse events (TEAEs), serious TEAEs (TESAEs), relapse rates, and vaccination timing from the last RTX dose. Of the 58 patients enrolled, 89.7% were female, with a mean age of 47.4 years, and 21/58 (36.2%) were RTX-exposed. Relapses occurred in 12/21 (57.1%) RTX-exposed patients between their first RTX dose and study entry. The safety profile of ravulizumab was generally similar between RTX-exposed and RTX-naïve groups. Common TEAEs included COVID-19, headache, urinary tract infection, and upper respiratory tract infection. UTIs were more frequent in RTX-exposed individuals. One patient in each group experienced a meningococcal infection. No adjudicated on-trial relapses were reported while on ravulizumab. Following initiation of ravulizumab, RTX-exposed and RTX-naïve patients with AQP4-Ab+ NMOSD achieved sustained disease control and demonstrated a manageable safety profile. The CHAMPION-NMOSD Trial; ClinicalTrials.gov identifier: NCT04201262 (registered October 06, 2020).

This study aimed to explore the clinical characteristics of patients with lupus myocarditis (LM) and to evaluate the efficacy of rituximab (RTX) in LM treatment. The medical records of all patients with LM admitted to our hospital between January 2012 and March 2025 were retrospectively analyzed. Two control groups were established by randomly matching patients by sex and age at a 1:1 ratio: patients with systemic lupus erythematosus (SLE) without LM and patients with non-SLE myocarditis. The SLE disease activity index 2 K (SLEDAI 2 K) score and Systemic Lupus Erythematosus Disease Activity Score (SLE-DAS) were calculated to evaluate SLE disease activity. A total of 22 patients with LM were enrolled. Patients with LM had a higher incidence of lupus nephritis and a higher positivity rate for anti-SSB antibodies than those with SLE without LM. Furthermore, patients with SLE with LM had significantly higher SLE-DAS than those without LM, although no statistical difference in SLEDAI 2 K score was observed between the groups. Wall motion abnormalities, valvular regurgitation, and decreased left ventricular ejection fraction (LVEF) were more frequent in patients with LM than in those with non-SLE myocarditis. All patients with LM received corticosteroid treatment, with three of them receiving RTX in addition to standard therapy. With a median follow-up of 4 (range, 1-24) months, 2 patients (9.1%) died due to heart failure, and the remaining 20 achieved symptom remission. Moreover, 13 patients underwent follow-up echocardiography, which showed a significant improvement in LVEF. The three patients treated with RTX achieved clinical improvement within a mean of 2 weeks, enabling rapid glucocorticoid tapering. Patients with LM more frequently present with lupus nephritis and positive anti-SSB antibodies, are more likely to have echocardiographic abnormalities, and exhibit a higher mortality rate. In addition, RTX is a promising drug for LM treatment.