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Rituximab-mediated ...
Rituximab-mediated late-onset neutropenia in systemic lupus erythematosus - distinct roles of BAFF and APRIL
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- Parodis, I (author)
- Karolinska Institutet
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Soder, F (author)
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- Faustini, F (author)
- Karolinska Institutet
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- Kasza, Z (author)
- Karolinska Institutet
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Samuelsson, I (author)
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- Zickert, A (author)
- Karolinska Institutet
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- Svenungsson, E (author)
- Karolinska Institutet
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- van Vollenhoven, RF (author)
- Karolinska Institutet
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- Malmstrom, V (author)
- Karolinska Institutet
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- Wermeling, F (author)
- Karolinska Institutet
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- Gunnarsson, I (author)
- Karolinska Institutet
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(creator_code:org_t)
- 2018-05-21
- 2018
- English.
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In: Lupus. - : SAGE Publications. - 1477-0962 .- 0961-2033. ; 27:9, s. 1470-1478
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http://kipublication...
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https://doi.org/10.1...
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Abstract
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- Rituximab-mediated late-onset neutropenia (LON) has been described in various diseases. We investigated its occurrence, consequences and contributing factors in patients with systemic lupus erythematosus (SLE). Methods Rituximab-treated patients from the Karolinska University Hospital ( n = 107) were surveyed. LON was defined as an absolute neutrophil count <1500 cells/μl, occurring four weeks to two years following rituximab treatment, or later during sustained B-cell depletion. Serum levels of B-cell-related cytokines and growth factors of the myeloid lineage were determined using enzyme-linked immunosorbent assay. Results Thirty-two patients (29.9%) developed LON after a median time of 201.5 days. Thirteen patients were admitted to the hospital; 10 due to fever. Three patients developed critical conditions. BAFF levels increased from baseline (median: 0.62 ng/ml) to the post-treatment evaluation (median: 1.16 ng/ml; p < 0.001); post-treatment levels were higher in the LON group ( p = 0.021). APRIL levels were higher in the LON group both at baseline (median: 1.54 versus 1.15 ng/ml; p = 0.027) and post-treatment (median: 2.39 versus 1.11 ng/ml; p = 0.011). IL-6 and GM-CSF levels decreased in the non-LON group ( p < 0.001), but not in LON patients. High baseline disease activity predicted LON development (OR: 4.1; 95% CI: 1.1–15.2 for SLEDAI-2K > 8). No association with neutropenia prior to rituximab treatment was documented. Conclusion Post-rituximab LON was a common complication. Although the phenomenon was predominantly self-limiting, several patients developed severe conditions. Distinct roles of BAFF and APRIL are implicated: BAFF may contribute to LON development, whereas high APRIL levels may be predictive. Rituximab-treated SLE patients should be monitored for neutrophil counts, fever and infections.
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Lupus
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- By the author/editor
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Parodis, I
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Soder, F
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Faustini, F
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Kasza, Z
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Samuelsson, I
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Zickert, A
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show more...
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Svenungsson, E
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van Vollenhoven, ...
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Malmstrom, V
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Wermeling, F
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Gunnarsson, I
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show less...
- Articles in the publication
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Lupus
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Karolinska Institutet