Successful high‐titer immunoglobulin therapy for persistent parvovirus B19 infection in a lymphoma patient treated with rituximab‐combined chemotherapy

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Abstract
A 40‐year‐old female diagnosed with follicular lymphoma was treated with rituximab‐combined chemotherapy. Although she achieved complete remission, she developed progressive anemia and reticulocytopenia. Bone marrow examination revealed features of pure red cell aplasia and hemophagocytosis. In addition, the appearance of large pronormoblasts suggested that she was infected with parvovirus B19. Excess viral DNA in her bone marrow confirmed that her illness was caused by persistent parvovirus B19 infection. Serum immunoglobulin levels decreased beyond the lower normal limit, which indicated that her humoral immunity was impaired after rituximab‐combined chemotherapy. Although she had been infected with parvovirus B19, she was re‐infected and failed to control the viral expansion. High‐titer immunoglobulin against parvovirus B19 was intravenously administrated and resulted in remarkable reticulocytosis and improvement of anemia. High‐titer immunoglobulin, which contained a sufficient amount of neutralizing antibodies against parvovirus B19, likely inactivated most viruses in vivo. We successfully eradicated the virus after 2 courses of high‐dose therapy at 0.5 g/kg/day every week followed by 8 courses of maintenance therapy at 0.1 g/kg/day every other week. It is important to consider that parvovirus B19 infection is a possible cause of progressive anemia in B‐cell lymphoma patients treated with rituximab‐combined chemotherapy. We propose that the use of high‐titer immunoglobulin against parvovirus B19 may enable such immunocompromised patients to eradicate the virus before sufficient immune system reconstruction. Am. J. Hematol. 77:370–373, 2004.