Although more than a third of MO would administer gamma globulin and continue rituximab maintenance in this situation, the faculty and a majority of MO would discontinue treatment. This approach is based primarily on the fact that rituximab maintenance has not been shown to increase overall survival and recurrent infections can cause a major detriment to quality of life.

Casulo C et al. Incidence of hypogammaglobulinemia in patients receiving rituximab and the use of intravenous immunoglobulin for recurrent infections. Clin Lymphoma Myeloma Leuk 2013;13(2):106-11. Abstract

De Angelis F et al. Risk of secondary hypogammaglobulinaemia after rituximab and fludarabine in indolent non-Hodgkin lymphomas: A retrospective cohort study. Leuk Res 2015;[Epub ahead of print]. Abstract