Repeated courses of rituximab for autoimmune cytopenias may precipitate profound hypogammaglobulinaemia requiring replacement intravenous immunoglobulin

Rituximab is increasingly being used for autoimmune diseases (Arnold et al, 2007; Godeau et al, 2008). A recent report in the British Journal of Haematology detailed the long-term follow-up (median 39·5 months) of 49 paediatric patients treated with rituximab, and described a 69% response rate and no major infections or long-term toxicities (Parodi et al, 2009). However, many patients will relapse, requiring further therapy that results in...