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Safety of RituximabMore than 500,000 patients worldwide have received rituximab. Serious adverse events have occurred in only a limitednumber of these patients, while in the majority of patients,rituximab is safe and well tolerated [35]. However, notably,there have been several reports on serious adverseevents related to rituximab. Progressive multi focal leukoencephalopathy is a serious adverse event of rituximab (http://www.fda.gov/safety/medwatch/safetyinformation/safety-related drug label ingchanges /ucm123013.htm). Fetal hepatitis by reactivation of hepatitis B virus is also a seriousadverse event induced by rituximab[36].Inrecent studies ofpatients with complicated nephrotic syndrome who had beentaking rituximab, a pediatric patient died because of pulmonary fibrosis [37]. Kamei et al. also reported that respiratory events, such as cough, bronchospasm, and dyspnea,are relatively common as adverse effects of rituximab [38].Sellier-Leclerc et al. reported a patient with fulminantmyocarditis due to enterovirus who underwent hearttransplant surgery [39]. Additional severe adverse effectsreported in childhood nephrotic syndrome include Pneumocystis carinii pneumonia [28, 40] and severe immune-mediated ulcerative colitis [41]. These complicationsmight have been underestimated in the literature. Althoughlong-term safety data on anti-CD20 therapy are broadlyreassuring, a mortality rate of 3 % has been reported in the3 years following its initiation in patients with a variety ofautoimmune diseases [42], mainly due to infection. Thelong-term consequences of rituximab infusions in childrenare not known.
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