小剂量利妥昔单抗靶向控制循环B淋巴细胞治疗难治性自身免疫性溶血性贫血

Treatment of refractory autoimmune hemolytic anemia with low dose rituximab targeting circulating B lymphocytes

目的:评估小剂量利妥昔单抗靶向控制循环B淋巴细胞数量治疗难治性自身免疫性溶血性贫血(AIHA)的疗效及不良反应。方法:2014-10-2019-09期间31例难治性AIHA接受利妥昔单抗100 mg,每周1次,连续使用至外周循环中CD19^+细胞降低至流式细胞仪常规检测下限0.1%。结果:经中位2个疗程(1~4个疗程)的利妥昔单抗治疗,患者循环CD19细胞比例降至0.1%以下,总体有效率87.1%(27/31)。输注相关不良反应1例(3.2%),1周内发生感染2例(6.5%)。中位无复发生存时间13个月(2~26个月)。结论:小剂量利妥昔单抗治疗AIHA,疗效佳且不良反应较少,值得临床进一步探索。

Objective:To evaluate the efficacy and adverse events of low-dose rituximab targeting the circulating B lymphocytes in the treatment of refractory autoimmune hemolytic anemia(AIHA).Method:From October 2014 to September 2019,31 patients with refractory AIHA were administrated with rituximab 100 mg once a week until the CD19^+ cells in the peripheral circulation reduced to the lower limit of 0.1% by flow cytometry.Result:After an median 2 courses(1 to 4 courses) of rituximab treatment,the proportion of circulating CD19 cells decreased to less than 0.1%.The overall effective rate was 87.1%(27/31).One case(3.2%) had transfusion related adverse events,and 2 cases(6.5%) had infection within one week.The median recurrence free survival time was 13 months(2 to 26 months).Conclusion:Low dose rituximab is effective and with well tolerated in the treatment of refractory AIHA,which is worth further clinical exploration.