Progressive multifocal leukoencephalopathy after rituximab therapy in HIV-negative patients: a report of 57 cases from the Research on Adverse Drug Events and Reports project
Progressive multifocal leukoencephalopathy after rituximab therapy in HIV-negative patients: a report of 57 cases from the Research on Adverse Drug Events and Reports project
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DOI：
10.1182/blood-2008-10-186999
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发表时间：
2009-05-14
期刊：
影响因子：
20.3
通讯作者：
Bennett, Charles L.
中科院分区：
文献类型：
--
作者：
Carson, Kenneth R.;Evens, Andrew M.;Bennett, Charles L.
利妥昔单抗可改善淋巴增生性疾病患者的预后，并越来越多地用于治疗免疫介导性疾病。最近的报道描述了2名系统性红斑狼疮和1名类风湿关节炎患者在接受利妥昔单抗治疗后发展为进行性多灶性白质脑病(PML)。我们回顾了1997-2008年间美国食品和药物管理局、制造商、医生对接受利妥昔单抗治疗的患者的PML病例描述和文献综述。总体而言，52例淋巴增生性疾病患者，2例系统性红斑狼疮患者，1例类风湿关节炎患者，1例特发性自身免疫性全血细胞减少症患者，1例免疫性血小板减少症患者在利妥昔单抗和其他药物治疗后发展为PML。其他治疗包括造血干细胞移植(7例)、嘌呤类似物(26例)或烷化剂(39例)。1名自身免疫性溶血性贫血患者在使用皮质类固醇和利妥昔单抗治疗后发展为PML，1名自身免疫性全血细胞减少患者在使用皮质类固醇、硫唑嘌呤和利妥昔单抗治疗后发展为PML。从最后一次注射利妥昔单抗到诊断为PML的中位时间为5.5个月。PML确诊后的中位死亡时间为2.0个月。病死率为90%。需要在接受利妥昔单抗治疗的患者中认识到PML的可能性。(血。2009；113：4834-4840)
Rituximab improves outcomes for persons with lymphoproliferative disorders and is increasingly used to treat immune-mediated illnesses. Recent reports describe 2 patients with systemic lupus erythematosus and 1 with rheumatoid arthritis who developed progressive multifocal leukoencephalopathy (PML) after rituximab treatment. We reviewed PML case descriptions among patients treated with rituximab from the Food and Drug Administration, the manufacturer, physicians, and a literature review from 1997 to 2008. Overall, 52 patients with lymphoproliferative disorders, 2 patients with systemic lupus erythematosus, 1 patient with rheumatoid arthritis, 1 patient with an idiopathic autoimmune pancytopenia, and 1 patient with immune thrombocytopenia developed PML after treatment with rituximab and other agents. Other treatments included hematopoietic stem cell transplantation (7 patients), purine analogs (26 patients), or alkylating agents (39 patients). One patient with an autoimmune hemolytic anemia developed PML after treatment with corticosteroids and rituximab, and 1 patient with an autoimmune pancytopenia developed PML after treatment with corticosteroids, azathioprine, and rituximab. Median time from last rituximab dose to PML diagnosis was 5.5 months. Median time to death after PML diagnosis was 2.0 months. The case-fatality rate was 90%. Awareness is needed of the potential for PML among rituximab-treated persons. (Blood. 2009;113:4834-4840)