How do you handle hypogammaglobulinemia detected in patients prior to maintenance rituximab infusion?  

That is a good question. Adding on to Dr. @Peter A. Merkel's response, rituximab has been shown to cause hypogammaglobulinemia that can persist or worsen with ongoing therapy. In a study published by Barmettler and colleagues, 133 patients out of a cohort of 8633 patients had serum IgG levels checke...

There is a lack of clear evidence or guidance on whether to monitor immunoglobulin levels in patients receiving repeated courses of rituximab or about how to react to findings of hypoimmunoglobulinemia. The absolute risk of infection in patients on rituximab who are hypoimmunoglobulinemic is not kno...