Effects of rituximab therapy on B cell differentiation and depletion

Clin Rheumatol. 2020 May;39(5):1415-1421. doi: 10.1007/s10067-020-04996-7. Epub 2020 Feb 22.


Rituximab is a human/murine chimeric anti-CD20 monoclonal antibody. It is largely used to treat B cell malignancies and has become standard in the management of B cell‑mediated diseases such as rheumatoid arthritis and granulomatosis with polyangitis. The effects of rituximab need to be monitored by B cell phenotyping. Evaluate possible surface markers for monitoring B cell development in response to rituximab treatment. This review discusses the literature on the B cell surface markers analysed by flow cytometry in patients treated with rituximab. A panel of biomarkers of response to treatment to monitor by flow cytometry is also suggested. B cell phenotyping is useful to predict clinical relapses after rituximab treatment. The proposed panel of biomarkers includes CD38++CD24++IgD+/- immature B cells and IgD-CD38+/- memory B cells. In responders, Th1/Th2 balance and tolerance cells (CD4+CD25+CD127-/low Treg cells and CD19+CD24hiCD38hi Breg cells) tend to be restored after rituximab therapy. Furthermore, in responder patients, indirect depletion of CD19+/-CD27++CD38++ preplasma cells can be proposed as a predictor of response. Flow cytometric analysis of samples from patients treated with rituximab is a useful strategy to stratify patients according to response to treatment. Identification of B cell differentiation stages by means of a specific flow cytometry panel could improve monitoring of rituximab effects and enable non-responders to be distinguished from good responders.

Keywords: B cells; Flow cytometry; Rituximab; T cells.

Publication types

  • Review

MeSH terms

  • Antigens, CD / metabolism*
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / drug therapy
  • Arthritis, Rheumatoid / metabolism
  • B-Lymphocytes / drug effects*
  • B-Lymphocytes / metabolism
  • Biomarkers / metabolism
  • Cell Differentiation / drug effects*
  • Flow Cytometry
  • Granulomatosis with Polyangiitis / drug therapy
  • Granulomatosis with Polyangiitis / metabolism
  • Humans
  • Rituximab / therapeutic use*


  • Antigens, CD
  • Antirheumatic Agents
  • Biomarkers
  • Rituximab