小剂量利妥昔单抗治疗慢性特发性血小板减少性紫癜疗效分析

Efficacy of lower dose rituximab therapy for idiopathic thrombocytopenic purpura

目的探讨小剂量利妥昔单抗（抗CD20单抗）治疗慢性特发性血小板减少性紫癜（ITP）临床疗效、安全性及患者免疫学改变。方法采用小剂量利妥昔单抗（100mg，每周1次，共4次）治疗26例对糖皮质激素和免疫球蛋白治疗无效的慢性ITP患者，检测治疗前后血常规，免疫球蛋白和血小板相关抗体及淋巴细胞亚群CD3^＋、CD3^＋CD4^＋、CD3^＋CD8^＋、CD3^-CD56^＋、CD4^＋CD25^＋、CD4^＋CD25^＋FOXP3^-、CD4^＋CD25^＋FOXP3^＋和CD19^＋CD20^＋细胞。结果26例患者，完全缓解（CR）6例（23．1％），有效（R）10例（38．5％），其中1例复发，无效（NR）10例（38．5％）。中位随访时间5．5（0．8～8）个月，起效和达CR中位时间分别为27（1～104）d和41（4～109）d。治疗前后免疫球蛋白定量和CD3^＋、CD3^＋CD4^＋、CD3^＋CD8^＋、CD3^-CD56^＋、CD4^＋CD25^＋、CD4^＋CD25^＋FOXP3^＋细胞计数差异无统计学意义。治疗后的CD4^＋CD25^＋FOXP3^-细胞计数比治疗前降低（P〈0．05）。治疗后的CD19^＋CD20^＋细胞计数与治疗前相比明显减少（P〈0．01）。治疗后血小板相关抗体PAIgG比治疗前减低（P〈0．05）。26例患者均无明显的不良反应。结论小剂量利妥昔单抗可能是一种高效、安全治疗ITP的药物，但其最佳用药方案、长期疗效以及不良反应仍有待临床进一步观察，

Objective To evaluate the effectiveness, safety as well as the immunological change （ peripheral T cell subpopulation） in patients with idiopathic thrombocytopenic purpura （ITP） treated with lower dose rituximab. Methods Twenty-six patients with refractory ITP which were unresponsive to or relapse after steriod and IVIG treatment were treated with rituximab （100 mg per week for four weeks） and intravenous immunoglobulin（IVIG） treatment. Whole blood cell count, serum concentrations of IgG, IgM and IgA, platelet associated （PA）-IgG, PAIgA and PAIgM, peripheral T cell subpopulations, and B cells of CD19^＋/CD20^＋ were detected before and after rituximab therapy. Results Complete response （CR） was achieved in 6 patients （23.1%）, response（R） in 10 （38.5%）, and non-response（NR） in 10 （38.5%）. One patient relapsed after R. The median follow-up time was 5.5 （0.8 - 8 ） months. The median response and CR time were 27（ 1 - 104） and 41 （4 - 109） days, respectively. After the therapy, the serum concentrations of IgG, IgA, IgM, T cells of CD3^＋ , CD3^＋CD4^＋ , CD3^＋CD8^＋ , CD3^-CD56^＋ , CD4^＋CD25^＋ and CD4^＋ CD25^＋ FOXP3^＋ were not changed, the number of CD4^＋CD25^＋ FOXP3^- T cells decreased （ P 〈 0.05 ） and CD19^＋ CD20^＋ B cells significantly decreased （P 〈0. 01 ）. PAIgG was lower after treatment compared with that before treatment （ P 〈 0.05 ）. There were no severe adverse effects during rituximab therapy. Conclusion Lower dose rituximab may be an effective and safe modality for patients with ITP.