CD20^+B细胞淋巴瘤治疗中利妥昔单抗相关间质性肺炎的风险因素及治疗

The risk factors and treatment of rituximab-related interstitial pneumonia in CD20^+B cell lymphoma

目的:探讨利妥昔单抗(rituximab)在CD20^+B细胞淋巴瘤(B cell lymphoma,BCL)治疗中其相关间质性肺炎发生的可能风险因素和治疗方法。方法:回顾性分析6例CD20^+BCL利妥昔单抗相关间质性肺炎与临床和免疫表型特征、细胞起源的相关性及有效治疗方法。结果:在临床特征上,6例患者间质性肺炎诊断前1周内均伴粒细胞缺乏或减少,CD20^+BCL初发时乳酸脱氢酶(lactic dehydrogenase,LDH)值均明显增高,为正常值的1.5~10倍以上,其中2例>2000 U/L者,间质性肺炎最为严重。在免疫表型特征上,6例间质性肺炎患者均呈双表达(Bcl-2^+Bcl-6^+c-Myc^+、Bcl-2^+c-Myc^+或Bcl-6^+c-Myc^+);6例患者中5例为非生发中心型,1例为生发中心型。所有患者的Ki-67均高达80%~90%。经以甲基强的松龙为主的治疗5~9 d,6例间质性肺炎患者全部治愈。结论:具有双表达、非生发中心和Ki-67增高等免疫特征和粒细胞缺乏、LDH增高等因素可能与利妥昔单抗相关间质性肺炎的风险因素有关,以甲基强的松龙为主的治疗可能是有效治疗方法。

Objective:To investigate the risk factors and treatment for rituximab-related interstitial pneumonia in patients with CD20^+B cell lymphoma(BCL).Methods:To retrospectively analyze the clinical date of 6 CD20^+BCL patients with rituximab-related interstitial pneumonia.The correlation between risk factors of rituximab-related interstitial pneumonia with their clinical and pathological characteristics,lymphoma cell origination and therapeutic regimes.Results:In terms of clinical features,all 6 patients suffered granulocytopenia or agranulocytosis within 1 week before the diagnosis of interstitial pneumonia.Striking increases in the lactic dehydrogenmase(LDH)level ranging from 1.5 to 10 times of baseline at the beginning of CD20^+BCL diagnosis were observed,especially in the two most serious case whose LDH were over 2000 U/L.For immunopathological features,6 interstitial pneumonia patients were double expressed(Bcl-2^+BCL-6^+c-Myc^+,Bcl-2^+c-Myc^+or Bcl-6^+c-Myc^+).6 Interstitial pneumonia patients were non-germinal-center B cell like lymphoma(non-GCB),while the rest one was germinal-center B cell like lymphoma(GCB).Ki-67 were up to 80%-90%in all the patients.The patients were treated with methylprednisolone-based therapy for 5-9 d,all patinets of interstitial pneumonia were cured.Conclusion:The CD20^+BCL patients with double expression,non-GCB,high Ki-67,granulocytopenia,and high serum LDH level were more reliable to have rituximab-related interstitial pneumonia.Systemic methylprednisolone-based therapy is an effective therapeutic regimen.