单次利妥昔单抗治疗原发免疫性血小板减少症的疗效及安全性

doi:10.6040/j.issn.1671-7554.0.2018.210

摘要/Abstract

摘要： 目的研究单次500 mg利妥昔单抗治疗糖皮质激素无效或复发的成人原发免疫性血小板减少症的临床疗效及安全性。方法收集2015年1月至12月就诊于山东大学齐鲁医院血液内科,确诊为原发免疫性血小板减少症经糖皮质激素治疗疗效不佳或复发的患者资料30例,利妥昔单抗500 mg单次给药,观察其临床疗效、起效时间、药效维持时间及不良反应。结果 30例患者治疗后完全缓解13例(43.33%),有效9例(30.00%),无效8例(26.67%)。完全缓解及有效的患者(n=22)中,中位起效时间为30 d(7~60 d),15例(68.18%)疗效维持时间超过1年,疗效维持时间最短者为3个月;未出现严重不良反应。结论单次500 mg利妥昔单抗治疗原发免疫性血小板减少症安全、有效,且能减少患者住院时间及次数,可用于经激素治疗无效或复发的原发免疫性血小板减少症的治疗。

关键词: 原发免疫性血小板减少症, 利妥昔单抗, 疗效

Abstract: Objective To investigate the activity, safety and response duration of single dose rituximab(RTX)in previously treated primary immune thrombocytopenia(ITP). Methods Thirty patients with ITP who had failed to respond to glucocorticosteroids were treated with a single dosage of 500 mg rituximab in Department of Hematology, Qilu Hospital of Shandong University. The clinical effect, onset time, duration of efficacy and adverse reactions were observed. Results Response and complete response were achieved in 9(30.00%)and 13(43.33%)patients, respectively. In responders, the median time to response was 30 days(range: 7-60 d). Sustained response was maintained for over 12 months in 68.18%(15/22)patients with the shortest sustained response time of 3 months. No serious infectious, hematologic or extra-hematologic complications were documented during follow-up. Conclusion The single dose of 500 mg rituximab may be effective and safe for corticosteroid-resistant or relapsed patients with ITP.

Key words: Immune thrombocytopenia, Rituximab, Efficacy

中图分类号:

R574

聂牧,倪晓菲,秦平,杨丹丹,李强,侯明,彭军,张晓琳,石艳. 单次利妥昔单抗治疗原发免疫性血小板减少症的疗效及安全性[J]. 山东大学学报 (医学版), 2018, 56(5): 81-84.

NIE Mu, NI Xiaofei, QIN Ping, YANG Dandan, LI Qiang, HOU Ming, PENG Jun, ZHANG Xiaolin, SHI Yan. Safety and efficacy of single dose rituximab in primary immune thrombocytopenia[J]. Journal of Shandong University (Health Sciences), 2018, 56(5): 81-84.

参考文献

[1] Zufferey A, Kapur R, Semple JW. Pathogenesis and therapeutic mechanisms in immune thrombocytopenia(ITP)[J]. J Clin Med, 2017, 6(2): 16-37.
[2] Cines DB, Cuker A, Semple JW. Pathogenesis of immune thrombocytopenia[J]. Presse Med, 2014, 43(2):49-59.
[3] 刘月波, 周泽平, 杨红, 等. 小剂量美罗华治疗原发免疫性血小板减少症的临床疗效观察[J]. 昆明医科大学学报, 2012, 33(11):99-101. LIU Yuebo, ZHOU Zeping, YANG Hong, et al. Efficacy of low-dose rituximab for patients with immune thrombocytopenia[J]. Journal of Kunming Medical University, 2012, 33(11): 99-101.
[4] Ghanima W, Godeau B, Cines DB, et al. How I treat immune thrombocytopenia: the choice between splenectomy or a medical therapy as a second-line treatment[J]. Blood, 2012, 120(5): 960-969.
[5] Auger S, Duny Y, Rossi JF, et al. Rituximab before splenectomy in adults with primary idiopathic thrombocytopenic purpura: a meta-analysis[J]. Br J Haematol, 2012, 158(3): 386-398.
[6] Grace RF, Bennett CM, Ritchey AK, et al. Response to steroids predicts response to rituximab in pediatric chronic immune thrombocytopenia[J]. Pediatr Blood Cancer, 2012, 58(2): 221-225.
[7] Zaja F, Volpetti S, Chiozzotto M, et al. Long-term follow-up analysis after rituximab salvage therapy in adult patients with immune thrombocytopenia[J]. Am J Hematol, 2012, 87(9): 886-889.
[8] Reboursiere E, Fouques H, Maigne G, et al. Rituximab salvage therapy in adults with immune thrombocytopenia: retrospective study on efficacy and safety profiles[J]. Int J Hematol, 2016, 104(1): 85-91.
[9] Zaja F, Vianelli N, Volpetti S, et al. Low-dose rituximab in adult patients with primary immune thrombocytopenia[J]. Eur J Haematol, 2010, 85(4): 329-334.
[10] 中华医学会血液学分会止血与血栓学组.成人原发免疫性血小板减少症诊断与治疗中国专家共识(2016年版)[J].中华血液学杂志,2016,37(2):89-93.
[11] Garcia-Suarez J, Prieto A, Reyes E, et al. The clinical outcome of autoimmune thrombocytopenic purpura patients is related to their T cell immunodeficiency[J]. Br J Haematol, 1993, 84(3): 464-470.
[12] 姚春花. 小剂量利妥昔单抗在原发免疫性血小板减少症患者中的应用[J]. 中外医学研究, 2016, 14(12): 162-164.
[13] 隋涛, 张磊, 周泽平,等. 两种小剂量利妥昔单抗治疗方案治疗原发免疫性血小板减少症疗效比较[J]. 中华血液学杂志, 2011, 32(9): 583-586. SUI Tao, ZHANG Lei, ZHOU Zeping, et al. Efficacy and safety of two different low-dose rituximab regimens for Chinese adult patients with immune thrombocytopenia[J]. Chinese Journal of Hematology, 2011, 32(9): 583-586.
[14] Stasi R, Pagano A, Stipa E, et al. Rituximab chimeric anti-CD20 monoclonal antibody treatment for adults with chronic idiopathic thrombocytopenic purpura[J]. Blood, 2001, 98(4): 952-957.
[15] British Committee for Standards in Haematology General Haematology Task Force. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy[J]. Br J Haematol, 2003, 120(4): 574-596.
[16] Brah S, Chiche L, Fanciullino R, et al. Efficacy of rituximab in immune thrombocytopenic purpura: a retrospective survey[J]. Ann Hematol, 2012, 91(2):279-285.
[17] 郭素丽, 陈娜飞, 魏秋平,等. 小剂量与标准剂量利妥昔单抗治疗老年慢性难治性免疫性血小板减少症的临床研究[J]. 实用医学杂志, 2013, 29(13): 2197-2198.
[18] Gudbrandsdottir S, Birgens HS, Frederiksen H, et al. Rituximab and dexamethasone vs dexamethasone monotherapy in newly diagnosed patients with primary immune thrombocytopenia[J]. Blood, 2013, 121(11): 1976-1981.
[19] Cervinek L, Cerná O, Caniga M, et al. Efficacy of rituximab in primary immune thrombocytopenia: an analysis of adult pretreated patients from everyday hematological practice[J]. Int J Hematol, 2012, 96(5): 594-599.
[20] Khellaf M, Charlesnelson A, Fain O, et al. Safety and efficacy of rituximab in adult immune thrombocytopenia: results from a prospective registry including 248 patients[J]. Blood, 2014, 124(22): 3228-3236.
[21] Mahévas M, Ebbo M, Audia S, et al. Efficacy and safety of rituximab given at 1,000 mg on days 1 and 15 compared to the standard regimen to treat adult immune thrombocytopenia[J]. Am J Hematol, 2013, 88(10): 858-861.
[22] Gómez-Almaguer D, Tarín-Arzaga L, Moreno-Jaime B, et al. High response rate to low-dose rituximab plus high-dose dexamethasone as frontline therapy in adult patients with primary immune thrombocytopenia[J]. Eur J Haematol, 2013, 90(6): 494-500.
[23] 李丹, 胡俊, 刘顺妹,等. 标准剂量与小剂量利妥昔单抗治疗难治性免疫性血小板减少症的临床研究[J]. 医学综述, 2015(3):571-573. LI Dan, HU Jun, LIU Shunmei, et al. Clinical study of standard dose and small dose of rituximab treating refractory immune thrombocytopenia[J]. Medical Recapitulate, 2015(3): 571-573.
[24] Zaja F, Battista ML, Pirrotta MT, et al. Lower dose rituximab is active in adults patients with idiopathic thrombocytopenic purpura[J]. Haematologica, 2008, 93(6): 930-933.
[25] Cooper N, Stasi R, Cunninghamrundles S, et al. The efficacy and safety of B-cell depletion with anti-CD20 monoclonal antibody in adults with chronic immune thrombocytopenic purpura[J]. Br J Haematol, 2004, 125(2): 232-239.

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