美罗华嵌合anti-CD20单克隆抗体治疗成人难治性特发性血小板减少性紫癜。

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Braendstrup P, Bjerrum噢,尼尔森橙汁,詹森英航,克劳森NT,汉森PB,安徒生,施密特K,安徒生TM, Peterslund NA, Birgens HS, Plesner T,皮德森BB, Hasselbalch HC

美罗华嵌合anti-CD20单克隆抗体治疗成人难治性特发性血小板减少性紫癜。

J内科杂志。2005年4月,78 (4):275 - 80。

PubMed ID
15795920 (在PubMed
]
文摘

特发性血小板减少性紫癜是一种免疫性疾病涉及调理素作用的血小板自身抗体针对不同的表面糖蛋白,由网状内皮系统导致他们过早破坏。管理难治性ITP患者是很困难的。最近的研究表明,利妥昔单抗,嵌合anti-CD20单克隆抗体,在这些患者的治疗是有用的,整体响应率约为50%。beplayapp大多数发表的报告包括少数病人包括案例报告。本研究报告回顾丹麦多中心研究的结果的利妥昔单抗治疗成人难治性ITP患者。35例患者(平均年龄52年,范围17 - 82年,17岁男性)都包括在内。一个病人免疫血小板和中性粒细胞减少。所有患者接受强的松(Pred)。Pred旁边,用大剂量免疫球蛋白治疗25例,并在16个病人脾切除术已被执行。16岁患者治疗用药。 Other treatments included, e.g., cyclosporine, danazol, cyclophosphamide, vincristine, interferon, and dexamethasone. The patients were treated with a dose regimen of 375 mg/m2 i.v. approximately once weekly for 4 consecutive weeks. Six patients received a fixed dose of 500 mg disregarding their weight supplemented by 100 mg of methylprednisone i.v. or 50-100 mg of Pred given as premedication together with an antihistamine just before infusion of rituximab. The large majority of patients also received Pred and, in some cases, other concomitant immunosuppressive treatment during part of their rituximab treatment. A complete response (CR) was defined as a rise in the platelet count > 100 x 10(9)/L, a partial response (PR) as a rise in the platelet count > 50 x 10(9)/L, and a minor response (MR) as a rise in the platelet count < 50 x 10(9)/L. No response (NR) was defined as no increase in the platelet count. Because 4 patients were treated twice, a total of 39 outcomes of rituximab treatment were evaluated. Rituximab proved to be effective in 17 of 39 treatments [overall response 44% with 7 CR (18%) (1 patient showed a CR twice), 6 PR (15%), and 4 MR (10%)]. In 9/13 cases of CR or PR, the response (platelet level > 50 x 10(9)/L) was prompt, 1-2 weeks after the first infusion. The remaining patients responded 3-8 weeks later. Patients with CR and PR have been in remission for a median of 47 weeks. In general the side effects were few. In 2 cases, the treatment was stopped because of side effects either during or after the first infusion. Two fatal outcomes were recorded. A 71-year-old female with severe lung disease died 6 days after the first infusion of respiratory failure. The other patient, a 73-year-old man also with severe chronic obstructive lung disease, died of pneumonia approximately 13 weeks following the last rituximab treatment. It is concluded that rituximab may be a useful alternative therapy in patients with severe and symptomatic ITP refractory to conventional treatment.

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