Background: The Anti-CD20 monoclonal antibody Rituximab suppresses B-lymphocytes
and may induce hypogammaglobulinemia in treated patients. The incidence and clinical significance
of rituximab induced hypogammaglobulinemia in lymphoma patients is underestimated.
Methods: We retrospectively analyzed the rates of hypogammaglobulinemia, infection and infectionrelated
mortality in 136 lymphoma patients who were treated with a combination of chemotherapy and
Results: Rituximab given in more than 8 doses (OR 6.05, 95% CI: 1.24-29.5), relative hypogammaglobulinemia at time of
lymphoma diagnosis (OR 4.2, 95% CI: 1.26-14.1) and the combination of fludarabine with rituximab (OR 3.4, 95% CI:
1.24-9.47) were factors significantly associated with prolonged (more than 6 months) hypogammaglobulinemia. The
combination of fludarabine and rituximab (OR 6.4, 95% CI: 1.49-27.0) and secondarily prolonged hypogammaglobulinemia
(OR 4.5, 95% CI: 1.19-18.5) were found to be predictive factors for severe infections and infection-related mortality.
Conclusion: These data suggest the importance of following serum immunoglobulin levels before and after combination
immuno-chemotherapy, particularly in patients with recurrent infections or relapsed/refractory disease.