Vnitr Lek 2016, 62(5):398-405

Treatment with rituximab as an opportunity for the prevention of infectious complications

Pavel Polák^1,2,*, Miroslav Penka^1,3,4, Petr Smejkal^1,3, Gabriela Chlupová^1,3

¹ Oddělení klinické hematologie FN Brno

² Klinika interní, geriatrie, ošetřovatelství a praktického lékařství LF MU a FN Brno, pracoviště Bohunice

³ Katedra laboratorních metod LF MU Brno

⁴ Interní hematologická a onkologická klinika LF MU a FN Brno, pracoviště Bohunice

Rituximab, a monoclonal antibody against the surface antigen of B-lymphocytes CD20 is beeing used in the treatment of numerous hematological, hematooncological and autoimmune disorders. After administration of rituximab, quick and almost complete depletion of B-lymphocytes with the exception of pre-B-lymphocytes and plasma cells occur. Neutropenia and low serum antibody levels in classes IgA, IgM and IgG may also develop. These changes usually persist for 6-12 months, rarely for several years. In the consequence, patients with the rituximab treatment are more prone to infections - usually of bacterial and viral origin. Concomitantly, rituximab treatment influences negatively postvaccination antibody production and therefore adequate preventive measures are necessary before the beginning of the treatment. The authors offer complex overview of actual literature, emphasize adequate education of patients as well as of healthcare providing staff and discuss the vaccination recommendation against preventable communicable diseases like influenza, pneumococcal diseases, tetanus, diphtheria and pertussis.

Keywords: autoimmune disease; immunosupression; infectious complications; prevention; rituximab; vaccination

Received: January 15, 2016; Accepted: February 15, 2016; Published: May 1, 2016  Show citation