Research ArticleArticle
Late-onset Neutropenia in Patients with Rheumatoid Arthritis after Treatment with Rituximab
Rita Abdulkader, Chethana Dharmapalaiah, Ginny Rose, Lynne M. Shand, Gavin P. Clunie and Richard A. Watts
The Journal of Rheumatology March 2014, jrheum.130526; DOI: https://doi.org/10.3899/jrheum.130526
Rita Abdulkader
From the Research and Development Department, Department of Rheumatology, The Ipswich Hospital NHS Trust, Ipswich, UK. RAW and GPC have received support from the Norfolk and Suffolk Comprehensive Local Research Network. R. Abdulkader, MD, Rheumatology specialist trainee, Rheumatology Department, Norfolk and Norwich University Hospital, Norwich; C. Dharmapalaiah, MB, BS, Rheumatology specialist trainee, Rheumatology Department, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon; G. Rose, RN, BSc (Hons), Senior research nurse, Research and Development Department, The Ipswich Hospital NHS Trust; L.M. Shand, MB, ChB, Consultant rheumatologist, Rheumatology Department, The Ipswich Hospital NHS Trust; G.P. Clunie, MB, BS, MD, Consultant rheumatologist, Cambridge University Hospitals NHS Foundation Trust, Cambridge; R.A. Watts, BM, BCh, DM, Consultant rheumatologist, Rheumatology Department, The Ipswich Hospital NHS Trust. Address correspondence to Dr. R. Abdulkader, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK. E-mail: ritaadel@doctors.org.uk. Accepted for publication December 30, 2013.
Chethana Dharmapalaiah
From the Research and Development Department, Department of Rheumatology, The Ipswich Hospital NHS Trust, Ipswich, UK. RAW and GPC have received support from the Norfolk and Suffolk Comprehensive Local Research Network. R. Abdulkader, MD, Rheumatology specialist trainee, Rheumatology Department, Norfolk and Norwich University Hospital, Norwich; C. Dharmapalaiah, MB, BS, Rheumatology specialist trainee, Rheumatology Department, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon; G. Rose, RN, BSc (Hons), Senior research nurse, Research and Development Department, The Ipswich Hospital NHS Trust; L.M. Shand, MB, ChB, Consultant rheumatologist, Rheumatology Department, The Ipswich Hospital NHS Trust; G.P. Clunie, MB, BS, MD, Consultant rheumatologist, Cambridge University Hospitals NHS Foundation Trust, Cambridge; R.A. Watts, BM, BCh, DM, Consultant rheumatologist, Rheumatology Department, The Ipswich Hospital NHS Trust. Address correspondence to Dr. R. Abdulkader, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK. E-mail: ritaadel@doctors.org.uk. Accepted for publication December 30, 2013.
Ginny Rose
From the Research and Development Department, Department of Rheumatology, The Ipswich Hospital NHS Trust, Ipswich, UK. RAW and GPC have received support from the Norfolk and Suffolk Comprehensive Local Research Network. R. Abdulkader, MD, Rheumatology specialist trainee, Rheumatology Department, Norfolk and Norwich University Hospital, Norwich; C. Dharmapalaiah, MB, BS, Rheumatology specialist trainee, Rheumatology Department, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon; G. Rose, RN, BSc (Hons), Senior research nurse, Research and Development Department, The Ipswich Hospital NHS Trust; L.M. Shand, MB, ChB, Consultant rheumatologist, Rheumatology Department, The Ipswich Hospital NHS Trust; G.P. Clunie, MB, BS, MD, Consultant rheumatologist, Cambridge University Hospitals NHS Foundation Trust, Cambridge; R.A. Watts, BM, BCh, DM, Consultant rheumatologist, Rheumatology Department, The Ipswich Hospital NHS Trust. Address correspondence to Dr. R. Abdulkader, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK. E-mail: ritaadel@doctors.org.uk. Accepted for publication December 30, 2013.
Lynne M. Shand
From the Research and Development Department, Department of Rheumatology, The Ipswich Hospital NHS Trust, Ipswich, UK. RAW and GPC have received support from the Norfolk and Suffolk Comprehensive Local Research Network. R. Abdulkader, MD, Rheumatology specialist trainee, Rheumatology Department, Norfolk and Norwich University Hospital, Norwich; C. Dharmapalaiah, MB, BS, Rheumatology specialist trainee, Rheumatology Department, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon; G. Rose, RN, BSc (Hons), Senior research nurse, Research and Development Department, The Ipswich Hospital NHS Trust; L.M. Shand, MB, ChB, Consultant rheumatologist, Rheumatology Department, The Ipswich Hospital NHS Trust; G.P. Clunie, MB, BS, MD, Consultant rheumatologist, Cambridge University Hospitals NHS Foundation Trust, Cambridge; R.A. Watts, BM, BCh, DM, Consultant rheumatologist, Rheumatology Department, The Ipswich Hospital NHS Trust. Address correspondence to Dr. R. Abdulkader, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK. E-mail: ritaadel@doctors.org.uk. Accepted for publication December 30, 2013.
Gavin P. Clunie
From the Research and Development Department, Department of Rheumatology, The Ipswich Hospital NHS Trust, Ipswich, UK. RAW and GPC have received support from the Norfolk and Suffolk Comprehensive Local Research Network. R. Abdulkader, MD, Rheumatology specialist trainee, Rheumatology Department, Norfolk and Norwich University Hospital, Norwich; C. Dharmapalaiah, MB, BS, Rheumatology specialist trainee, Rheumatology Department, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon; G. Rose, RN, BSc (Hons), Senior research nurse, Research and Development Department, The Ipswich Hospital NHS Trust; L.M. Shand, MB, ChB, Consultant rheumatologist, Rheumatology Department, The Ipswich Hospital NHS Trust; G.P. Clunie, MB, BS, MD, Consultant rheumatologist, Cambridge University Hospitals NHS Foundation Trust, Cambridge; R.A. Watts, BM, BCh, DM, Consultant rheumatologist, Rheumatology Department, The Ipswich Hospital NHS Trust. Address correspondence to Dr. R. Abdulkader, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK. E-mail: ritaadel@doctors.org.uk. Accepted for publication December 30, 2013.
Richard A. Watts
From the Research and Development Department, Department of Rheumatology, The Ipswich Hospital NHS Trust, Ipswich, UK. RAW and GPC have received support from the Norfolk and Suffolk Comprehensive Local Research Network. R. Abdulkader, MD, Rheumatology specialist trainee, Rheumatology Department, Norfolk and Norwich University Hospital, Norwich; C. Dharmapalaiah, MB, BS, Rheumatology specialist trainee, Rheumatology Department, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon; G. Rose, RN, BSc (Hons), Senior research nurse, Research and Development Department, The Ipswich Hospital NHS Trust; L.M. Shand, MB, ChB, Consultant rheumatologist, Rheumatology Department, The Ipswich Hospital NHS Trust; G.P. Clunie, MB, BS, MD, Consultant rheumatologist, Cambridge University Hospitals NHS Foundation Trust, Cambridge; R.A. Watts, BM, BCh, DM, Consultant rheumatologist, Rheumatology Department, The Ipswich Hospital NHS Trust. Address correspondence to Dr. R. Abdulkader, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK. E-mail: ritaadel@doctors.org.uk. Accepted for publication December 30, 2013.

Abstract
Objective Late-onset neutropenia (LON) is an adverse effect of rituximab (RTX) in hematological malignancies, a finding that was recently reported in rheumatoid arthritis (RA). The aim of our study was to estimate its incidence in RA.
Methods We retrospectively reviewed complete blood (cell) count of patients with RA who received RTX between October 2007 and July 2011 to identify neutropenia (≤ 1.5 × 109) up to 12 months following RTX.
Results One hundred eight patients received RTX, median age 64 years (range 25 –86). A total of 237 cycles were given. Five patients developed LON after a median of 151 days (71–184). Two developed pneumonia.
Conclusion LON occurs infrequently after RTX, but can present with infection.
In this issue
The Journal of Rheumatology
Vol. 52, Issue 2
1 Feb 2025
Late-onset Neutropenia in Patients with Rheumatoid Arthritis after Treatment with Rituximab
Rita Abdulkader, Chethana Dharmapalaiah, Ginny Rose, Lynne M. Shand, Gavin P. Clunie, Richard A. Watts
The Journal of Rheumatology Mar 2014, jrheum.130526; DOI: 10.3899/jrheum.130526