Treatment of posttransplant lymphoproliferative disease with rituximab: the remission, the relapse, and the complication.
Treatment of posttransplant lymphoproliferative disease with rituximab: the remission, the relapse, and the complication.
复制标题
用利妥昔单抗治疗移植后淋巴增殖性疾病：缓解、复发和并发症。
作者：
E. Verschuuren;S. Stevens;G. V. van Imhoff;Jaap M Middeldorp;C. de Boer;G. Köeter;T. The;W. van der Bij
背景
利妥昔单抗是一种人源化的抗CD 20单克隆抗体，是治疗移植后淋巴组织增生性疾病（PTLD）的一种很有前途的新工具，尤其适用于移植有排斥反应倾向的重要器官移植患者，如肺移植后患者。到目前为止，没有描述任何严重并发症。我们用利妥昔单抗治疗了三名肺移植受者，因为PTLD。
方法
患者接受每周4次剂量为375 mg/m2的利妥昔单抗治疗。用竞争性定量聚合酶链反应检测EB病毒DNA，用流式细胞术检测循环B细胞。
结果
利妥昔单抗治疗导致所有患者完全缓解，无闭塞性细支气管炎综合征体征或进展。患者1在2个月后复发，具有部分CD 20阴性PTLD，但在放疗后稳定缓解。患者2在治疗后16个月完全缓解，但患者3发展为低丙种球蛋白血症，并在6个月后死于侵袭性曲霉病。在利妥昔单抗治疗前，在患者2和3的血液样品中可检测到EBV DNA，并且在利妥昔单抗治疗后立即变为阴性。在所有三名患者中，在用利妥昔单抗治疗后7个月（死亡时）、16个月和16个月，外周血中不存在B细胞。抗增殖剂，如霉酚酸酯（MMF），可能会延长B细胞耗竭。
结论
利妥昔单抗对PTLD的治疗是有效的，在我们的患者中没有移植功能障碍的进展。并发症包括部分CD 20阴性的PTLD复发和低丙种球蛋白血症。应注意免疫球蛋白G（IgG）水平，尤其是在接受抗增殖药物（如MMF）治疗的患者中。
BACKGROUND
Rituximab, a humanized anti-CD20 monoclonal antibody, is a promising new tool for the treatment of posttransplant lymphoproliferative disease (PTLD), especially for patients transplanted with rejection prone transplants of vital organs, such as patients after lung transplantation. Thus far, no major complications have been described. We treated three lung transplant recipients with Rituximab because of PTLD.
METHODS
Patients were treated with four weekly doses of 375 mg/m2 of Rituximab. Epstein-Barr virus (EBV) DNA was monitored with quantitative-competitive polymerase chain reaction and circulating B cells with flow cytometry.
RESULTS
Treatment with Rituximab resulted in a complete remission in all patients without signs of or progression of bronchiolitis obliterans syndrome. Patient 1 relapsed after 2 months with a partly CD20-negative PTLD but is in stable remission after radiotherapy. Patient 2 is in complete remission 16 months after treatment, but patient 3 developed a hypogammaglobulinemia and died of invasive aspergillosis after 6 months. EBV DNA was detectable in the blood samples of patients 2 and 3 before treatment with Rituximab and became negative instantly after Rituximab. In all three patients, B cells are absent in the peripheral blood 7 months (at death), 16 months, and 16 months after treatment with Rituximab. Antiproliferating agents, such as mycophenolate mofetil (MMF), might prolong B-cell depletion.
CONCLUSIONS
Rituximab was effective for the treatment of PTLD without progression of transplant dysfunction in our patients. Complications were a partly CD20-negative relapse of PTLD and a hypogammaglobulinemia. Attention should be paid to immunoglobulin G (IgG) levels, especially in patients treated with antiproliferating agents such as MMF.
影响因子：
4.4
作者：
M. Nalesnik;M. Nalesnik;L. Makowka;T. Starzl;T. Starzl
通讯作者：
M. Nalesnik;M. Nalesnik;L. Makowka;T. Starzl;T. Starzl
Epstein-Barr病毒在口咽上皮细胞中的复制。
DOI：
10.1056/nejm198405103101905
发表时间：
1984
期刊：
The New England journal of medicine
影响因子：
--
作者：
Sixbey,JW;Nedrud,JG;Raab-Traub,N;Hanes,RA;Pagano,JS
通讯作者：
Pagano,JS