The use of rituximab in the treatment of malignant and nonmalignant plasma cell disorders.
The use of rituximab in the treatment of malignant and nonmalignant plasma cell disorders.
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利妥昔单抗在治疗恶性和非恶性浆细胞疾病中的用途。
作者：
S. Treon;K. Anderson
CD 20是一种B细胞限制性抗原，其大部分在B细胞分化的前B细胞至成熟B细胞阶段表达。在B细胞分化过程中，有几种转录因子调节CD 20的表达，其中最重要的似乎是PU.1和Pip（PU.1相互作用蛋白）。随着B细胞分化为浆细胞，CD 20表达下调，这与浆细胞中的PU. 1下调一致。类似于它们的正常B细胞对应物，CD 20在来自大多数瓦尔登斯特伦巨球蛋白血症患者的恶性淋巴浆细胞和来自一部分（20%）多发性骨髓瘤患者的恶性浆细胞上表达。CD 20也在正常供体浆细胞的亚群上表达，其可包括分泌自身抗体的浆细胞。鉴于这些发现，抗CD 20嵌合单克隆抗体利妥昔单抗（Rituxan; Genentech，Inc，South San弗朗西斯科，CA和IDEC Pharmaceutical Corporation，San Diego，CA），已在治疗瓦尔登斯特伦巨球蛋白血症和多发性骨髓瘤以及非恶性浆细胞疾病（包括IgM多神经病、免疫性血小板减少症和自身免疫性溶血性贫血）中进行了评价，与这些实体报告的活动有关。本报告介绍了这些临床工作的更新。
CD20 is a B-cell-restricted antigen that, for the most part, is expressed from the pre-B-cell to the mature B-cell stage of B-cell differentiation. Several transcription factors regulate CD20 expression during B-cell differentiation, the most important of which appear to be PU.1 and Pip (PU.1 interacting protein). As B cells differentiate to plasma cells, CD20 expression is down-regulated, which coincides with PU.1 downregulation in plasma cells. Analogous to their normal B-cell counterparts, CD20 is expressed on malignant lymphoplasmacytic cells from most patients with Waldenstrom's macroglobulinemia and on malignant plasma cells from a fraction (20%) of multiple myeloma patients. CD20 also is expressed on subpopulations of normal donor plasma cells, which may include autoantibody-secreting plasmacytes. In view of these findings, the anti-CD20 chimeric monoclonal antibody, rituximab (Rituxan; Genentech, Inc, South San Francisco, CA and IDEC Pharmaceutical Corporation, San Diego, CA), has been evaluated in the treatment of Waldenstrom's macroglobulinemia and multiple myeloma, as well as in nonmalignant plasma cell disorders including IgM polyneuropathies, immune thrombocytopenias, and autoimmune hemolytic anemias, with reported activity in these entities. An update of these clinical efforts is presented in this report.