摘要
目的探讨小剂量利妥昔单抗治疗继发于系统性红斑狼疮（SLE）的难治性血细胞减少症的临床疗效及安全性。方法选择2009年10月至2014年12月沈阳军区总医院收治的继发于SLE的难治性血细胞减少症患者11例，给予利妥昔单抗100mg静脉滴注，每周1次，连用4周；动态观察血常规变化，采用流式细胞术检测治疗前后CD3^＋、CD19^＋CD20^＋淋巴细胞数，免疫比浊法定量检测治疗前后血清免疫球蛋白（IgG、IgM、IgA）水平。治疗有效患者序贯给予每6个月静脉滴注利妥昔单抗100mg行维持治疗，通过长期随访评价维持治疗有效性。结果小剂量利妥昔单抗初始治疗后6例完全缓解，3例部分缓解，2例无效，总有效率为81．8％。利妥昔单抗治疗前后血清免疫球蛋白及CD3^＋淋巴细胞数无明显变化（P〉0．05），但CD19^＋CD20^＋淋巴细胞数较治疗前明显下降（P〈0．01），并达到清除水平。初始治疗完全缓解的6例患者及部分缓解的3例患者均接受了每6个月100mg利妥昔单抗的维持治疗，随访期间完全缓解的6例患者均未复发，部分缓解的3例患者中1例获得完全缓解，1例维持部分缓解，1例复发。结论小剂量利妥昔单抗治疗继发于SLE的难治性血细胞减少症安全有效，而对治疗有效的患者序贯维持治疗能有效减少复发，但其最佳用药方案尚需更多病例观察加以验证。
Objective To investigate the efficacy and safety of low - dose rituximab therapy and sequential maintenance for secondary cytopenia associated with systemic lupus erythematosus（SLE）. Methods From October 2009 to December 2014,Eleven patients with secondary cytopenia associated with SLE received intravenous rituximab at the dose of 100 mg once weekly for 4 consecutive weeks in the General Hospital of Shenyang Military Command.Complete blood cell count and serum concentrations of immunoglobulin（IgG,IgM and IgA） were monitored regularly.The numbers of CD3^＋ and CD19^＋CD20^＋ lymphocyte cells were assayed by flow cytometry prior to and following therapy.The patients acquired responses（complete remission and partial remission） were maintained with rituximab 100 mg every six months. The efficacy of maintenance therapy was evaluated through long-term follow-up. Results The responses were of 6 CR（complete remission）,3 PR（partial remission） and 2 NR,respectively. The total effective rate was 81.8%.There were no significant changes of serum immunoglobulin and CD3＊ lymphocyte counts during prior and post treatment（P〉0.05）.However,CD19^＋CD20^＋ cells were almost decreased to depletion level in the patients treated with rituximab（P〈0.01）.Among six patients acquired CR,no one patient relapsed during the follow-up period because of sequential maintenance. Among three patients acquired PR,there was one patient achieved CR due to maintenance therapy,one patient relapsed and one patient remained PR. Conclusions Treatment with low dose rituximab may be an effective and safe approach in patient with secondary cytopenia associated with SLE.Relapse rates can be decreased through maintenance therapy with low dose rituximab. Howevert the optimal therapeutic schedule needs further investigation.
出处
《中国临床实用医学》
2016年第1期44-47,共4页
China Clinical Practical Medicine
