From the Research
After rituximab treatment, T cell proliferation typically remains intact while B cells are depleted. Rituximab is a monoclonal antibody that targets the CD20 antigen found on B lymphocytes, causing selective B cell depletion that can last 6-12 months while generally sparing T cell populations. This selective action occurs because CD20 is expressed almost exclusively on B cells and not on T cells, stem cells, or plasma cells. While T cell numbers and proliferation capacity usually remain normal following rituximab administration, some patients may experience indirect effects on T cell subsets due to altered cytokine environments or disrupted B-T cell interactions. In rare cases, late-onset neutropenia or hypogammaglobulinemia may develop, potentially affecting overall immune function. Clinicians should monitor complete blood counts and immunoglobulin levels during treatment, especially in patients receiving multiple courses. The preservation of T cell function explains why cell-mediated immunity remains largely intact during rituximab therapy, allowing patients to maintain defense against many intracellular pathogens despite B cell depletion.
According to the most recent study 1, primary prophylaxis for Pneumocystis jirovecii pneumonia (PJP) in patients receiving rituximab is justified, as it significantly reduces the incidence of PJP with a tolerable safety profile. However, this study does not directly address T cell proliferation. Another study 2 provides insight into the long-term effects of rituximab on immune reconstitution and B cell function, but its focus is on patients undergoing allogeneic hematopoietic cell transplantation.
Key points to consider:
- T cell proliferation remains intact after rituximab treatment
- B cell depletion can last 6-12 months
- Indirect effects on T cell subsets are possible due to altered cytokine environments or disrupted B-T cell interactions
- Clinicians should monitor complete blood counts and immunoglobulin levels during treatment
- Primary prophylaxis for PJP may be necessary in patients receiving rituximab, as shown in 1.
It is essential to prioritize the patient's overall immune function and monitor for potential complications, such as late-onset neutropenia or hypogammaglobulinemia, when administering rituximab. The most recent and highest-quality study 1 supports the use of primary prophylaxis for PJP in patients receiving rituximab, but its findings do not directly address T cell proliferation.