中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2012年
6期
456-459
,共4页
刘鸿%邢莉民%王化泉%吴玉红%瞿文%梁勇%王国锦%宋嘉%王晓明%关晶%李丽娟%付蓉%邵宗鸿
劉鴻%邢莉民%王化泉%吳玉紅%瞿文%樑勇%王國錦%宋嘉%王曉明%關晶%李麗娟%付蓉%邵宗鴻
류홍%형리민%왕화천%오옥홍%구문%량용%왕국금%송가%왕효명%관정%리려연%부용%소종홍
贫血,溶血性,自身免疫性%治疗结果%利妥昔单抗%环磷酰胺
貧血,溶血性,自身免疫性%治療結果%利妥昔單抗%環燐酰胺
빈혈,용혈성,자신면역성%치료결과%리타석단항%배린선알
Anemia,hemolytic,autoimmune%Treatment outcome%Rituximab%Cyclophosphamide
目的 探讨利妥昔单抗联合环磷酰胺(CTX)治疗难治性自身免疫性溶血性贫血的疗效和安全性.方法 2007年1月至2010年12月收治7例难治性自身免疫性溶血性贫血患者,其中1例为Evans综合征.利用以下方案进行治疗:利妥昔单抗375 mg/m2,1次/周,2～6个疗程；CTX1 g,1次/l0 d,2～7个疗程；同时加用静脉滴注免疫球蛋白5 g,1次/周,利妥昔单抗应用后ld使用.随访观察该方案的疗效与安全性.结果 所有患者治疗3个月时均有效(7/7),完全缓解率为6/7,部分缓解率为1/7,平均随访27个月.12个月时复查均未见复发；2例患者24个月复查时发现间接胆红素升高,网织红细胞升高,其中l例患者加用利妥昔单抗强化治疗后再达完全缓解,另1例患者继续用环孢素A维持治疗,36个月时复发,经加用上述利妥昔单抗联合CTX方案治疗3个疗程再达部分缓解.所有患者对该治疗方案耐受性好,不良反应轻微.结论 利妥昔单抗联合CTX治疗难治性自身免疫性溶血性贫血效果良好,不良反应轻微,但停药12 -24个月后部分患者有复发可能,再次强化治疗后仍有效.
目的 探討利妥昔單抗聯閤環燐酰胺(CTX)治療難治性自身免疫性溶血性貧血的療效和安全性.方法 2007年1月至2010年12月收治7例難治性自身免疫性溶血性貧血患者,其中1例為Evans綜閤徵.利用以下方案進行治療:利妥昔單抗375 mg/m2,1次/週,2～6箇療程；CTX1 g,1次/l0 d,2～7箇療程；同時加用靜脈滴註免疫毬蛋白5 g,1次/週,利妥昔單抗應用後ld使用.隨訪觀察該方案的療效與安全性.結果 所有患者治療3箇月時均有效(7/7),完全緩解率為6/7,部分緩解率為1/7,平均隨訪27箇月.12箇月時複查均未見複髮；2例患者24箇月複查時髮現間接膽紅素升高,網織紅細胞升高,其中l例患者加用利妥昔單抗彊化治療後再達完全緩解,另1例患者繼續用環孢素A維持治療,36箇月時複髮,經加用上述利妥昔單抗聯閤CTX方案治療3箇療程再達部分緩解.所有患者對該治療方案耐受性好,不良反應輕微.結論 利妥昔單抗聯閤CTX治療難治性自身免疫性溶血性貧血效果良好,不良反應輕微,但停藥12 -24箇月後部分患者有複髮可能,再次彊化治療後仍有效.
목적 탐토리타석단항연합배린선알(CTX)치료난치성자신면역성용혈성빈혈적료효화안전성.방법 2007년1월지2010년12월수치7례난치성자신면역성용혈성빈혈환자,기중1례위Evans종합정.이용이하방안진행치료:리타석단항375 mg/m2,1차/주,2～6개료정；CTX1 g,1차/l0 d,2～7개료정；동시가용정맥적주면역구단백5 g,1차/주,리타석단항응용후ld사용.수방관찰해방안적료효여안전성.결과 소유환자치료3개월시균유효(7/7),완전완해솔위6/7,부분완해솔위1/7,평균수방27개월.12개월시복사균미견복발；2례환자24개월복사시발현간접담홍소승고,망직홍세포승고,기중l례환자가용리타석단항강화치료후재체완전완해,령1례환자계속용배포소A유지치료,36개월시복발,경가용상술리타석단항연합CTX방안치료3개료정재체부분완해.소유환자대해치료방안내수성호,불량반응경미.결론 리타석단항연합CTX치료난치성자신면역성용혈성빈혈효과량호,불량반응경미,단정약12 -24개월후부분환자유복발가능,재차강화치료후잉유효.
Objective To assess the efficacy and safety of monoclonal antibody rituximab combined with cyclophosphamide (CTX) in the treatment of refractory and recurrent autoimmune hemolytic anemia.Methods Seven cases with refractory and recurrent autoimmune hemolytic anemia ( including 1 case of Evans syndrome) were recruited during January,2007 to December,2010.Treatment regimens were as follows:rituximab:375 mg/m2,1 time/week,2-6 courses; CTX:1 g,1/10 d,2-7 courses; combined with intravenous immunoglobulin (IVIG) 5 g,1 time/week,given 1 day after rituximab administration.The efficacy and safety of this regimen were assessed during follow-up.Results All the patients showed good responses (7/7).Six patients achieved complete remission (6/7) and one achieved partial remission ( 1/7 ).Average follow-up time for the patients was 27 months.All patients remained in remission during the 12-month follow-up visits.Two patients showed elevated indirect bilirubin and increased reticulocyte counts within 24 months.One patient achieved complete remission after additional rituximab therapy,and another patient remained partial remission after cyclosporine therapy.At the time of 36-month follow-up visit,the patient relapsed and was retreated with 3 courses of rituximab combined with CTX and eventually achieved partial remission.All patients tolerated the treatment well with few mild side effects.Conclusions Rituximab combined with CTX is effective and relatively safe in patients with refractory and recurrent autoimmune hemolytic anemia.Additional treatment to relapse patients about 12-24 months after drug withdrawal continues to be effective.
