{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T01:44:42Z","timestamp":1788572682616,"version":"build-2803163510"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T00:00:00Z","timestamp":1757894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Rituximab (RTX) is a widely used treatment for anti-MAG polyneuropathy, though standardized maintenance strategies are lacking. We aimed to compare two RTX retreatment protocols: (1) a full course (375 mg\/m<jats:sup>2<\/jats:sup>\/week for 4 weeks) administered at clinical relapse, and (2) a single infusion (375 mg\/m<jats:sup>2<\/jats:sup>) at reappearance of peripheral CD27+ B cells\u2014to evaluate their impact on disability progression over time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and methods<\/jats:title><jats:p>We retrospectively enrolled 29 patients with anti-MAG polyneuropathy, dividing them into two cohorts: (1) <jats:italic>relapse<\/jats:italic> (<jats:italic>n<\/jats:italic> = 19), treated with a full course at clinical relapse, or (2) <jats:italic>Kim's protocol<\/jats:italic> (<jats:italic>n<\/jats:italic> = 10), treated based on peripheral CD27+ B cell monitoring. Changes in INCAT, MRC sum score, and ISS from baseline to last follow-up were assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results and discussion<\/jats:title><jats:p>No significant changes in MRC scores were observed in either cohort. Both cohorts showed a significant reduction in INCAT scores at last follow-up, with a tendency toward greater improvement in <jats:italic>Kim's protocol<\/jats:italic> cohort. ISS scores were significantly lower in <jats:italic>Kim's protocol<\/jats:italic> cohort compared to the <jats:italic>relapse<\/jats:italic> cohort (<jats:italic>p<\/jats:italic> &amp;lt; 0.01). Importantly, patients treated according to Kim's protocol received a cumulative RTX dose ~2.5 times lower than those treated upon relapse (<jats:italic>p<\/jats:italic> &amp;lt; 0.0001), despite showing comparable or better clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A tailored maintenance strategy guided by peripheral CD27+ memory B-cell monitoring enables reduced cumulative RTX exposure while preserving clinical efficacy. This approach may improve cost-effectiveness and reduce treatment burden in patients with anti-MAG polyneuropathy.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1659670","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T04:12:57Z","timestamp":1757909577000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Rituximab retreatment guided by CD27+ B-cell count vs. clinical relapse in anti-MAG polyneuropathy: a cost-effective approach with lower cumulative 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