{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T02:14:40Z","timestamp":1781748880921,"version":"3.54.5"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"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. Oncol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Obinutuzumab, a type II anti-CD20 monoclonal antibody used in the treatment of follicular lymphoma, is associated with a higher incidence of adverse events, including thrombocytopenia, compared to rituximab. We report a case of severe, acute thrombocytopenia induced by obinutuzumab and explore its potential mechanism.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>A 47-year-old woman with follicular lymphoma developed recurrent, severe (grade III\u2013IV) thrombocytopenia within 24 h following obinutuzumab administration, starting from her second treatment cycle. Subsequent bone marrow aspiration revealed significant megakaryocyte hyperplasia but with impaired platelet production. Key laboratory findings included elevated levels of pro-inflammatory cytokines TNF-\u03b1 and IL-6, decreased complement levels, and reduced IgM, while the platelet antibodies tested were negative. The patient\u2019s thrombocytopenia was managed and improved with treatments including recombinant human thrombopoietin (rhTPO) and platelet transfusions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Obinutuzumab can rarely cause acute, severe thrombocytopenia, possibly through a combination of immune-mediated platelet destruction and impaired megakaryocyte maturation.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2025.1643313","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T04:14:06Z","timestamp":1760674446000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Acute obinutuzumab-induced thrombocytopenia in follicular lymphoma: case report and literature review"],"prefix":"10.3389","volume":"15","author":[{"given":"Jieyi","family":"Zhou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miaomiao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ce","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1038\/bcj.2016.42","article-title":"Obinutuzumab-induced coagulopathy in chronic lymphocytic leukaemia with trisomy 12","volume":"6","author":"Walter","year":"2016","journal-title":"Blood Cancer J"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2009-06-225979","article-title":"Increasing the efficacy of CD20 antibody therapy through the engineering of a new type II anti-CD20 antibody with enhanced direct and immune effector cell-mediated B-cell cytotoxicity","volume":"115","author":"Mossner","year":"2010","journal-title":"Blood"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1097\/CM9.0000000000001737","article-title":"Efficacy and safety of obinutuzumab for the first-line treatment of follicular lymphoma: a subgroup analysis of Chinese patients enrolled in the phase III GALLIUM study","volume":"135","author":"Hong","year":"2021","journal-title":"Chin Med J (Engl)"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2016.41","article-title":"Role of CD20 expression and other pre-treatment risk factors in the development of infusion-related reactions in patients with CLL treated with obinutuzumab","volume":"30","author":"Freeman","year":"2016","journal-title":"Leukemia"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2015-09-670802","article-title":"Cytokine release in patients with CLL treated with obinutuzumab and possible relationship with infusion-related reactions","volume":"126","author":"Freeman","year":"2015","journal-title":"Blood"},{"key":"B6","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1111\/bjh.15232","article-title":"A tale of two antibodies: obinutuzumab versus rituximab","volume":"182","author":"Freeman","year":"2018","journal-title":"Br J Haematol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.11406\/rinketsu.61.1616","article-title":"Acute thrombocytopenia after obinutuzumab administration in a patient with relapsed follicular lymphoma","volume":"61","author":"Sakai","year":"2020","journal-title":"Rinsho Ketsueki"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e751","DOI":"10.1097\/HS9.0000000000000751","article-title":"Successful use of intravenous immunoglobulins in an obinutuzumab-related acute thrombocytopenia","volume":"6","author":"Haage","year":"2022","journal-title":"Hemasphere"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.76.8960","article-title":"Immunochemotherapy with obinutuzumab or rituximab for previously untreated follicular lymphoma in the GALLIUM study: influence of chemotherapy on efficacy and safety","volume":"36","author":"Hiddemann","year":"2018","journal-title":"J Clin Oncol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.18826","article-title":"Obinutuzumab-induced acute thrombocytopenia: Report of two cases and review of literature","volume":"202","author":"Mechelfekh","year":"2023","journal-title":"Br J Haematol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1111\/imr.12370","article-title":"The platelet Fc receptor, FcgammaRIIa","volume":"268","author":"Qiao","year":"2015","journal-title":"Immunol Rev"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.12659\/AJCR.917644","article-title":"A case of rituximab-induced acute thrombocytopenia in a patient with splenic marginal zone lymphoma and chronic hepatitis C virus infection","volume":"20","author":"Qureini","year":"2019","journal-title":"Am J Case Rep"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.19147","article-title":"Frequency and outcomes of obinutuzumab-induced thrombocytopenia","volume":"203","author":"Ng","year":"2023","journal-title":"Br J Haematol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s40487-023-00259-y","article-title":"Acute thrombocytopenia complicating the initial administration of obinutuzumab: is it more frequent than we think","volume":"12","author":"Yilmaz","year":"2024","journal-title":"Oncol Ther"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1509567","article-title":"Obinutuzumab-induced acute thrombocytopenia: a case report and literature review","volume":"14","author":"Dou","year":"2024","journal-title":"Front Oncol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.5191-24","article-title":"Obinutuzumab-induced acute thrombocytopenia mimicking immune thrombocytopenia in a patient with follicular lymphoma","author":"Tane","year":"2025","journal-title":"Intern Med"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1177\/1078155219890023","article-title":"Successful rechallenge of rituximab following severe rituximab-induced acute thrombocytopenia in a patient with splenic marginal zone lymphoma","volume":"26","author":"Robinson","year":"2020","journal-title":"J Oncol Pharm Pract"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1177\/10781552221142870","article-title":"Rituximab-induced severe acute thrombocytopenia in a patient with splenic marginal zone lymphoma","volume":"29","author":"Kars","year":"2023","journal-title":"J Oncol Pharm Pract"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1643313\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T04:14:07Z","timestamp":1760674447000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1643313\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,17]]},"references-count":18,"alternative-id":["10.3389\/fonc.2025.1643313"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2025.1643313","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,17]]},"article-number":"1643313"}}