Chimaeric anti-CD20 monoclonal antibody (rituximab) in post-transplant B-lymphoproliferative disorder following stem cell transplantation in children
Chimaeric anti-CD20 monoclonal antibody (rituximab) in post-transplant B-lymphoproliferative disorder following stem cell transplantation in children
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DOI：
10.1046/j.1365-2141.2001.03041.x
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发表时间：
2001-10-01
影响因子：
6.5
通讯作者：
Vilmer, E
中科院分区：
文献类型：
--
作者：
Faye, A;Quartier, P;Vilmer, E
造血干细胞移植后的移植后淋巴细胞增生性疾病（PTLD）是一种严重的并发症，发生在8-22%具有高危因素的患者中。我们回顾性研究了12例b细胞PTLD患儿人源化抗cd20单克隆抗体（利妥昔单抗）作为一线治疗的耐受性和疗效。诊断时，8例患者有肿瘤累及。另外4例患者出现发热，伴有eb病毒（EBV）病毒载量升高和单克隆γ病。利妥昔单抗375 mg/ m(2)，每周1次，静脉滴注（1-9次）。只有1/48的输注与2级临床不良事件相关。12名患者中有8名（66%）对治疗有反应并完全缓解。所有无肿瘤累及的患者对治疗均有反应。所有应答者均在1周内迅速退烧。无应答者在第一周内没有表现出任何临床反应。肿瘤累及和免疫抑制似乎在无应答者中更为明显。利妥昔单抗是治疗b细胞PTLD的有效且耐受性良好的药物。肿瘤发生前的早期治疗似乎是最有效的方法。缺乏快速反应应导致PTLD治疗的加强。应该在进一步的纵向多中心研究中考虑和评估先发制人的治疗。
Post-transplant lymphoproliferative disorder (PTLD) after haemopoietic stem cell transplantation is a serious complication that occurs in 8-22% of patients with high-risk factors. We retrospectively investigated tolerance and efficacy of humanized anti-CD20 monoclonal antibody (rituximab) as first-line treatment in 12 children with B-cell PTLD. At diagnosis, eight patients had tumoral involvement. The other four patients had fever, associated with raised Epstein-Barr virus (EBV) viral load and monoclonal gammopathy. Rituximab was given at the dose of 375 mg/ m(2) once a week by intravenous infusion (1-9 infusions). Only 1/48 infusions was associated with a grade 2 clinical adverse event. Eight out of 12 (66%) patients responded to the treatment and were in complete remission. All patients without tumoral involvement responded to the treatment. A rapid decrease in fever within 1 week was observed in all responders. Non-responders did not show any clinical response during the first week. Tumoral involvement and immunodepression seemed to be more marked in nonresponders. Rituximab was an effective and well-tolerated treatment of B-cell PTLD. Early treatment before tumoral involvement seemed to be the most effective approach. Lack of rapid response should lead to intensification of PTLD treatment. Pre-emptive treatment should be considered and evaluated in further longitudinal multicentre studies.