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patients with chronic immune thrombocytopenic purpura: a double-blind randomized controlled trial. Lancet. 2008; 371: 395-403. 14. Bussel JB, Cheng G, Saleh MN, et al. Eltrombopag for the treatment of chronic idiopathic thrombocytopenic purpura. N Engl J Med. 2007;357: 2237-2247. 15. Edwards JC, Szczepanski L, Szechinski J, et al. Efficacy of B-cell-targeted therapy with rituximab in patients with rheumatoid arthritis. N Engl J Med. 2004;350: 2572-2581. 16. Ahmed ER, Spigelman Z, Cavacini LA, Posner MR. Treatment of pemphigus vulgaris with rituximab and intravenous

References 1. Zhong Y. Non-Hogkin’s lymphoma: what primary care professionals need to know. J Nurse Pract. 2006; 2:309-15. 10.1016/j.nurpra.2006.03.017 2. Hennessy BT, Hanrahan EO, Daly PA. Non-Hodgkin lymphoma: an update. The Lancet Oncol. 2004; 5: 341-53. 10.1016/S1470-2045(04)01490-1 3. Lu P. Staging and classification of lymphoma. Semin Nucl Med. 2005; 35:160-4. 10.1053/j.semnuclmed.2005.02.002 4. Sacchi S, Federico M, Dastoli G, Fiorani C, Vinci G, Clo‘ V, et al. Treatment of B-cell non-Hodgkin’s lymphoma with anti CD 20 monoclonal antibody Rituximab. Crit

References http://medical-dictionary.thefreedictionary.com/lymphoproliferative Primic Žakelj M, Bračko M, Hočevar M, Pompe-Kirn V, Strojan P, Zadnik V, Zakotnik B and Žagar T, editors. Cancer incidence in Slovenia 2006. Ljubljana: Institute of Oncology Ljubljana, Cancer registry of Republic of Slovenia; 2009. Cvetkovic RS, Perry CM. Rituximab: a review of its use in non-Hodgkin's lymphoma and chronic lymphocytic leukemia. Drugs 2006; 66 : 791-820. Molina A. A decade of rituximab: improving survival outcomes in non-Hodgkin's lymphoma. Annu Rev Med 2008; 59

Study Group. High versus standard dose methylprednisolone in the acute phase of idiopathic thrombotic thrombocytopenic purpura: a randomized study. Ann Hematol. 2010;89(6):591-596. 45. Scully M, McDonald V, Cavenagh J, et al. A phase 2 study of the safety and efficacy of rituximab with plasma exchange in acute acquired thrombotic thrombocytopenic purpura. Blood. 2011;118(7):1746-1753. 46. Froissart A, Buffet M, Veyradier A, et al. Efficacy and safety of first-line rituximab in severe, acquired thrombotic thrombocytopenic purpura with a suboptimal response to plasma

References Lucas BJ, Horning SJ. Monoclonal antibodies have finally arrived. In: Cavalli F, Armitage JO, Longo DL, editors. Annual of Lymphoid Malignancies. London: Martin Dunitz Ltd; 2001. p. 153-67. Jazirehi AR, Bonavida B. Cellular and molecular signal transduction pathways modulated by rituximab (rituxan, anti-CD20 mAb) in non-Hodgkin's lymphoma: implications in chemosensitization and therapeutic intervention. Oncogene 2005; 24 : 2121-43. Maloney DG, Liles TM, Czerwinski DK, Waldichuk C, Rosenberg J, Grillo-Lopez A, et al. Phase I clinical trial using

chemotherapy with rituximab and chlorambucil (R-LP), but was switched after only two cycles of R-LP to fludarabine and cyclophosphamide in combination with rituximab (R-FC) due to further disease progression. During this time, she suffered an episode of cutaneous herpes zoster, so valacyclovir prophylaxis was initiated. In January 2013, a transformation into DLBCL was confirmed and rituximab, cyclophosphamide, vincristine, doxorubicin and prednisolone (R-CHOP) chemotherapy regimen introduced. After 4 cycles of R-CHOP, disease remission was achieved and chemotherapy continued

London European Medicines Agency 2018 [6] European Medicines Agency. Guideline on similar biological medicinal products containing biotechnology-derived proteins as active substance: non-clinical and clinical issues. London: European Medicines Agency; 2014;1–13. European Medicines Agency Guideline on similar biological medicinal products containing biotechnology-derived proteins as active substance: non-clinical and clinical issues London: European Medicines Agency; 2014 1 13 [7] Jurczak W, Moreira I, Kanakasetty GB, et al. Rituximab biosimilar and reference rituximab

various common drugs implicated in iatrogenic HG are summarized in Table 1 . This list continues to expand with the rapid development of novel immunosuppressive and biologic therapies. In particular, the increasing popularity of anti-CD20 therapies, such as rituximab, has led to increasing reports of secondary antibody deficiency and fueled more research into its significance and treatment. Table 1 Common examples of drug-induced hypogammaglobinemia Anti-epileptics Immunosuppressants Monoclonal antibodies Others Carbamazepine Azathioprine Belimumab Antimalarial agents

-Hodgkincs lymphomas. N Engl J Med 1993; 329 : 987-94. Strojan-Flezar M, Lavrencak J, Zganec M, Strojan P. Image cytometric nuclear texture features in inoperable head and neck cancer: a pilot study. Radiol Oncol 2011; 45 : 40-50. Velnar T, Smrdel U, Popovic M, Bunc G. Genetic markers in oligodendroglial tumours. Radiol Oncol 2010; 44 : 13-8. Cvetkovic RS, Perry CM. Rituximab: a review of its use in non-Hodgkin's lymphoma and chronic lymphocytic leukemia. Drugs 2006; 66 : 791-820. Molina A. A decade of rituximab: improving survival outcomes in nonHodgkin's lymphoma

increase in inhibitor titer >21 BU/ml. Due to the ineffectiveness of previous therapeutic measures, after obtaining the approval of the Bioethics Committee of the Medical University of Warsaw and the patient’s parental consent, we decided to eradicate treatment-resistant inhibitor using rituximab 375 mg/m 2 , a widely advertised therapy at the time. The first dose of the new regimen was given in October 2010, and three subsequent doses were administered in 7-day intervals. Initial results were promising. After a fifth dose of rituximab, inhibitor titer reduction to <0