小剂量利妥昔单抗治疗复发难治性免疫性血小板减少症疗效分析  

Efficacy of Lower Dose Rituximab Therapy For Refractory Primary Immune Thrombocytopenic (ITP)

作　　者：刘先桃[1] 

机构地区：[1]赤峰市医院血液科,内蒙古赤峰024000

出　　处：《内蒙古医学杂志》2014年第10期1189-1191,共3页Inner Mongolia Medical Journal

摘　　要：目的 探讨小剂量利妥昔单抗治疗复发难治性免疫性血小板减少症（ITP）的疗效、安全性及治疗前后B细胞、血小板膜糖蛋白特异性自身抗体的变化.方法 利妥昔单抗100mg静脉滴注,每周1次,连用4周,治疗23例复发难治性ITP患者,无使用免疫抑制剂、化疗药、抗凝药及激素冲击疗法.监测治疗前后的血常规,血清免疫球蛋白（IgG、IgM、IgA）,血小板膜糖蛋白抗体及CD3＋、CD4＋、CD8＋、CD19＋、CD20＋细胞数.结果 9例完全有效,5例有效,9例无效.中位疗效持续时间8（5～23）个月,有效患者有中3例复发,其余均维持较好.有效患者治疗后血小板自身抗体均转阴.治疗前后外周血血红蛋白、白细胞计数无明显变化,血清IgG、IgM、IgA无明显变化,CD3＋、CD4＋、CD8＋细胞数无明显变化.治疗后CDI9＋/CD20＋细胞明显下降.多数患者耐受好.结论 小剂量利妥昔单抗治疗复发难治性ITP疗效肯定,不良反应可以耐受.Objective To evaluate the efficacy and safety of rituximab on B- lymphocytes and anti - platelet glycoprotein- specific antibodies in patients with refractory primary immune thrombocytopenic（ITP）. Methods 23 ITP patients with a median age of 36 years（range 1 6 - 56years）received solely intravenous rituximab at the dose of 100mg once weekly for consecutive 4 weeks. Lab studies included complete blood count, serum concentrations of IgG, IgM and IgA. CD3 ＋, CD4 ＋, CD8 ＋, CD19 ＋ and CD20 ＋ cell numbers were assayed by flow cytometry and anti- platelet glycoprotein- specific antibodies（GPⅡb/m a, GP Ⅰb/Ⅸ）were assayed by monolonal antibody- specific immobilisation of platelet antigens（MAIPA）prior to and following ritux- imab therapy. The response was evaluated according to the response criteria of international working group of ITP. Results Complete responses were achieved in 9 cases. Response in 5 cases, and no response in 9 cases. Responses were sustained 5 to 23 months（median 8 months）with 3 cases relapsed. After 4 weeks of rituximab therapy, GPU b/Ⅲ a and GP Ⅰb/Ⅺ disappeared in responded patients, and CD 19 ＋/CD20 ＋ cells were almost depleted in all patients. As expected, the serum concentrations of IgG, IgM, IgA, and the T cell counts were not changedAfter therapy. Three patients developed infusion - related reaction. Conclusion Rituximab is effective and safe, and the adverse reaction is tolerable.

关 键 词：血小板减少症 难治性 抗体 单克隆 CD20 

分 类 号：R554.6[医药卫生—血液循环系统疾病]