CAJ | 학술논문

目的探讨标准剂量利妥昔单抗治疗复发难治性原发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.方法利妥昔单抗每周375 mg/m2,静脉滴注,连用4周,治疗31例复发难治性ITP患者,不伴随使用免疫抑制剂、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GPⅡb/Ⅲa和(或)GP Ⅰb/Ⅸ特异性自身抗体及CD3+、CD4+、CD8+、CD19+、CD20+细胞数.结果 12例完全有效,7例有效,12例无效.中位疗效持续时间6(2～48)个月,有效患者4例复发,其余疗效均维持较好.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CD19+/CD20+细胞明显下降.多数患者耐受好.结论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.
목적 탐토표준제량리타석단항치료복발난치성원발면역성혈소판감소증(ITP)적료효、안전성급치료전후B세포、혈소판막당단백특이성자신항체적변화.방법 리타석단항매주375 mg/m2,정맥적주,련용4주,치료31례복발난치성ITP환자,불반수사용면역억제제、화료약、항응약급격소충격요법.감측치료전후적혈상규,혈청면역구단백(IgG、IgM、IgA),혈소판GPⅡb/Ⅲa화(혹)GP Ⅰb/Ⅸ특이성자신항체급CD3+、CD4+、CD8+、CD19+、CD20+세포수.결과 12례완전유효,7례유효,12례무효.중위료효지속시간6(2～48)개월,유효환자4례복발,기여료효균유지교호.유효환자치료후혈소판자신항체균전음.치료전후외주혈혈홍단백、백세포계수무명현변화,혈청IgG、IgM、IgA무명현변화,CD3+、CD4+、CD8+세포수무명현변화.치료후CD19+/CD20+세포명현하강.다수환자내수호.결론 리타석단항치료복발난치성ITP료효긍정,불량반응가이내수.
Objective To evaluate the efficacy and safety of rituximab on B-lymphocytes and antiplatelet glycoprotein-specific antibodies in patients with refractory primary immune thrombocytopenic (ITP).Methods Thirty-one ITP patients with a median age of 36 years (range 16 -56 years) received solely intravenous rituximab at the dose of 375 mg/m2 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 ( GP Ⅱ b/Ⅲ a,GP Ⅰ b/Ⅸ ) were assayed by monoclonal antibody-specific immobilisation of platelet antigens (MAIPA) prior to and following rituximab therapy. The response was evaluated according to the response criteria of international working group of ITP. Results Complete responses were achieved in 12 cases, response in 7 cases,and no response in 12 cases. Responses were sustained 2 to 28 months ( median 6 months) with 4 cases relapsed. After 4 weeks of rituximab therapy, GP Ⅱ b/Ⅲ a and GP Ⅰ b/Ⅸ disappeared in responded patients, and CD 19 +/CD20+ cells were almost depleted in all patients. As expected, the serum concentrations of IgG, IgM2 IgA, and the T cell counts were not changed after therapy. Four patients developed infusion-related reaction, 1 impaired renal function, and 3 secondary infections. Conclusion Rituximab is effective and safe, and the adverse reaction is tolerable.