抗CD_(20)单克隆抗体在非霍奇金淋巴瘤治疗中的应用

Application of the anti- CD_(20) monoclonal antibody (Rituximab) in the treatment of non- Hodgkin's lymphoma

目的探讨抗CD20单克隆抗体(美罗华)在非霍奇金淋巴瘤(NHL)治疗中的疗效。方法应用美罗华联合CHOP方案治疗NHL20例,其中初治18例,难治2例;用于自体造血干细胞移植的体内净化4例;维持治疗5例。结果诱导组20例中初治者18例,15例患者达到了完全缓解(CR),3例达到部分缓解(PR),CR率83%,总有效率100%。难治患者中1例达到PR,1例无疾病进展;未观察到美罗华对采集到的干细胞的质量和数量以及移植后造血恢复有不良影响,4例中2例细胞PCR免疫球蛋白重排(IgH)检测转阴;维持治疗组中5例全部存活(最长随访33个月)。结论美罗华联合化疗方案能够提高CD2+0NHL的疗效,有助于清除微小残留病灶,延长NHL的生存期。

Objective To assess the efficacy of the anti- CD20 monoclonal antibody (rituximab) in the treatment of non- Hodgkin's lymphoma (NHL). Methods Twenty patients with primary NHL (18 cases) and refractory NHL (2 cases) were treated by rituximab in combination of CHOP regimen. Four patients received autologous peripheral blood stem cell transplantation (auto- PBSCT) with in- vivo purging of Rituximab. Five patients received rituximab for the maintain therapy. Results Fifteen primary NHL patients in inducing group achieved complete response (CR) with 83 % of the CR rate. Three cases achieved partial response (PR). Overall response rate was 100 %. One case of refractory NHL achieved PR and the other was no disease progression. The obvious changes of the quantity or quality of the stem cells harvested were not observed. The hematopoietic reconstitution was comparable to the historical controls. Immunoglobulin heavy chain rearrangement detected by PCR turned negative post auto- PBSCT in 2/4 patients. All of 5 patients receiving the maintain therapy of rituximab were alive with 33 months median time of following- up. Conclusions Rituximab combined with chemotherapy could improve the efficacy in the patients with CD20 positive NHL. Rituximab could be used to eradicate the minimal residual disease and prolong the overall survival in NHL patients.