小剂量利妥昔单抗治疗成人免疫性血小板减少症的临床疗效

Clinical efficacy of lower dose rituximab in adult immune thrombocytopenia

目的探讨小剂量利妥昔单抗治疗成人免疫性血小板减少症（ITP）的安全性、有效性及其疗效的影响因素。方法收集我院2013年1月～2016年6月应用小剂量利妥昔单抗治疗的持续性和慢性成年ITP患者40例，观察其疗效及不良反应，并分析影响疗效的相关因素。结果40例患者中，男16例，女24例，年龄31．5（18～54）岁，病程32（3～330）个月，随访时间15．5（6—38）个月。利妥昔单抗治疗后3个月总有效（OR）和完全反应（CR）率分别为65．0％（26／40）和45．0％（18／40）；6个月的OR率和CR率分别为62．5％（25／40）和40．0％（16／40）；1年OR和CR率分别为66．7％（22／33）和33．3％（11／33）；随访末OR和CR率分别为47．5％（19／40）和25．0％（10／40）。26例OR患者的中位持续OR时间为15个月，18例CR患者的中位持续CR时间为12个月。利妥昔单抗输注过程中2例患者出现皮肤荨麻疹，1例出现发热；输注后2例患者出现上呼吸道感染，3例出现肺部感染，经治疗后均好转。血小板特异性抗体GPⅡb／Ⅲa及病程为利妥昔单抗治疗效果的可能影响因素。结论小剂量利妥昔单抗治疗成人持续性及慢性ITP疗效肯定，不良反应可以耐受。

Objective To investigate the safety and efficacy of lower close rituximab in adult immune thromboeytopenia（ITP） and analyze the influencing factors of treatment effect. Methods Forty adult patients with persistent and chronic ITP were treated with lower doses rituximab from January 2013 to June 2016 in our hospital. Efficacy and side effects of lower dose rituximab were studied, and the influencing factors of treatment effect were analyzed. Results The 40 patients included 16 males and 24 famales. Their ages varied from 18 to 54 years old with a median age of 31.5 years old. Their courses of disease varied from 3 to 330 months with a median course of 32 months. And the follow-up period varied from 6 to 38 months with a median time of 15.5 months. The overall response（OR） rate and the complete response （CR） rate were 65.0% （26/40） and 45.0% （18/40） at 3 months,62.5 % （25/40） and 40.0% （16/40） at 6 months, 66.7% （22/33） and 33. 3% （ 11/33 ） at 1 year after rituximab treatment, respectively. The OR and CR rate were 47.5% （19/40） and 25.0% （10/40） respectively at the end of follow-up. The median continuous OR duration in 26 patients achieving OR was 15 months while the median continuous CR duration in 18 patients achieving CR was 12 months. Skin urticaria occurred in 2 cases during the infusion and fever occured in 1 case. Three patients got pneumonia and 2 patients got upper respiratory infection after the infusion. But they all got better after treatments. Platelet anti-GPH b/Ⅲ a autoantibody and duration of ITP could be the influencing factors of rituximab treatment effect. Conclusion Lower dose rituximab is an effective treatment for adult ITP and adverse reactions can be tolerated.