利妥昔单克隆抗体治疗难治复发性特发性血小板减少性紫癜临床疗效初步评估  

Clinical Therapentic Efficacy of Rituximab for Relapsed and Refractory Idiopathic Thromocytopenic Purpura

作　　者：周立宇[1] 张征[1] 宋陆茜[1] 张曦[1] 苏基滢[1] 李晓[1] 常春康[1] 

机构地区：[1]上海交通大学附属第六人民医院血液科,上海200233

出　　处：《中国实验血液学杂志》2012年第4期941-944,共4页Journal of Experimental Hematology

摘　　要：本研究评价利妥昔单克隆抗体治疗难治复发性特发性血小板减少性紫癜(ITP)的临床疗效。选择我院2007年1月-2010年12月期间确诊为难治、复发性ITP患者18例,给予利妥昔单克隆抗体375 mg/m2静脉滴注,每周1次,连用4周为1个疗程。结果表明,18例患者接受22个疗程的利妥昔单克隆抗体治疗,治疗有效率为68%,完全反应率为45%,部分反应和微小反应率为23%,无效率为32%。自利妥昔单克隆抗体治疗开始中位治疗反应时间为3周(1-17周),中位疗效持续时间13周(1周-42个月)。大多数反应持续时间短,随访中位时间20个月(1-52个月),36%患者的治疗反应维持时间超过6个月,27%患者的治疗反应维持时间超过1年,随访结束,4例患者存在持续疗效。未行脾切除患者对利妥昔单克隆抗体治疗反应较脾切除患者好(P=0.037)。应用利妥昔单克隆抗体治疗失败及应用多种治疗手段包括脾切除的ITP患者后续治疗效果差。结论:利妥昔单克隆抗体治疗难治性、复发性ITP,疗效较好,患者容易耐受,20%左右患者有远期疗效。利妥昔单克隆抗体治疗失败ITP患者的后续治疗效果差。The aim of this study was to evaluate the effect of rituximab treatments for refractory and relapsed idiopathic thrombocytopenic purpura （ITP）. 18 patients with refractory and relapsed ITP who received 22 courses of rituximab treatments from January 2007 to December 2010 were analyzed retrospectively. Rituximab was given at a dose of 375 mg/m^2 introvenously weekly for a continuous 4 weeks. The results indicated that responses were achieved in 15 of 22 （68%） courses, out of which complete responses were achieved in 10 of 22 （45%） courses, partial and minimal responses were achieved in 5 of 22 （23%） courses, and no responses were achieved in 7 of 22 （32%） courses. The median time of response was 3 weeks （ 1 - 17 weeks） from the start of treatment and median duration of response was 13 weeks （ 1 week - 42 months）. The responses were mostly short - sustained and follow-up median time was 20 months （1 -52 months）. The responses of 8 patients （36%） sustained for over 6 months, 6 patients （27%） sustained for over 1 year, and 4 patients also showed sustained response at last visit of follow-up. Previous splenectomy resulted in a poor response （P = 0. 037 ）. Patients who failed in rituximab treatment and prior received multiple treatments including splenectomy, had a poor response to further therapies. It is concluded that rituximab is well tolerated by patients and is useful in some patients with relapsed and refractory ITP, however, only about 20% patients can achieve sustained remissions. The patients who failed in rituximab treatment has a poor response to further treatment.

关 键 词：难治复发性特发性血小板减少性紫癜 利妥昔单克隆抗体 

分 类 号：R558.2[医药卫生—血液循环系统疾病]