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William Bigot, Jean Francois Viallard, Jérémie Sellam, Azeddine Dellal, Aurélie Retbi, Delphine Gobert, Florent Malard, Mohamad Mohty, Arsène Mekinian, Olivier Fain, Efficacy and safety of rituximab for autoimmune neutropenia: a French case series and literature review, Rheumatology, Volume 59, Issue 9, September 2020, Pages 2637–2640, https://doi.org/10.1093/rheumatology/keaa045
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Sir, Autoimmune neutropenia is a rare disease characterized by neutrophil levels below 1500/mm3 and the presence of ANCA [1]. The treatment of autoimmune neutropenia is challenging, and optimal long-term therapies have not yet been established. Several approaches have been proposed for raising neutrophil levels in order to avoid severe infections. Among them, the use of steroids, IVIGs, and growth factors have been only poorly evaluated. Steroids have only a limited effect, while IVIGs are transiently effective in ∼50% of patients [2]. The most effective treatment for primary autoimmune neutropenia is G-CSF, which stimulates the proliferation and the maturation of progenitor cells, increases the production and the release of mature neutrophils, induces the demarginalization of neutrophils, reduces neutrophil apoptosis and downregulates neutrophil membrane antigen expression [3]. However, the effect of G-CSF is transient and suspensive, and relapse is usual at the discontinuation of G-CSF therapies. Rituximab has been shown to be an effective and safe therapy for autoimmune cytopenias, such as primary thrombocytopenia and autoimmune haemolytic anaemia. Only a few case reports about autoimmune neutropenia treated with rituximab have been reported. We aimed to evaluate the efficacy and safety of rituximab in autoimmune neutropenia, on the basis of a French retrospective study and literature review.
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