Hypogammaglobulinaemia after rituximab treatment-incidence and outcomes
Hypogammaglobulinaemia after rituximab treatment-incidence and outcomes
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DOI：
10.1093/qjmed/hcu094
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发表时间：
2014-10-01
影响因子：
13.3
通讯作者：
Seneviratne, S. L.
中科院分区：
文献类型：
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作者：
Makatsori, M.;Kiani-Alikhan, S.;Seneviratne, S. L.
背景资料：利妥昔单抗是一种抗CD 20的嵌合单克隆抗体，越来越多地用于治疗B细胞淋巴瘤和自身免疫性疾病。预期利妥昔单抗治疗后会出现一过性外周B细胞耗竭。虽然最初的临床试验并没有显示出显着的低丙种球蛋白血症，这是现在出现在literature.Methods的报告：我们进行了回顾性研究，以前与利妥昔单抗治疗的患者被称为临床免疫学与症状或严重的低丙种球蛋白血症。对患者的临床病史、免疫学标志物、利妥昔单抗治疗时间和静脉注射免疫球蛋白替代治疗（IVIG）的需要进行了评价。审计的患者接受利妥昔单抗的任何条件下，在12个月的时间和频率的低丙种球蛋白血症也carried.Results：我们确定了19后利妥昔单抗患者持续存在，症状panhypogammaglobulinaemia。平均IgG水平为3.42 +/- 0.4 g/l（正常范围5.8-16.3 g/l）。所有患者的B细胞减少或缺失。流感嗜血杆菌B、破伤风和肺炎球菌A型特异性抗体水平均降低，患者接种疫苗后未能产生免疫应答。几乎所有人最终都需要IVIG。从最后一次利妥昔单抗剂量到需要IVIG的平均间隔为36个月（范围7个月-7年）。值得注意的是，23.7%的114例患者包括在审计hypogammaglobulinaemia.Conclusion：随着越来越多地使用利妥昔单抗，重要的是临床医生治疗这些患者要知道hypogammaglobulinaemia和严重感染发生后，甚至数年完成治疗，并应积极寻找在后续。应考虑转诊至临床免疫学服务，如有指征，应考虑开始IVIG治疗。
Background: Rituximab, a chimeric monoclonal antibody against CD20, is increasingly used in the treatment of B-cell lymphomas and autoimmune conditions. Transient peripheral B-cell depletion is expected following rituximab therapy. Although initial clinical trials did not show significant hypogammaglobulinaemia, reports of this are now appearing in the literature.Methods: We performed a retrospective review of patients previously treated with rituximab that were referred to Clinical Immunology with symptomatic or severe hypogammaglobulinaemia. Patient clinical histories, immunological markers, length of rituximab treatment and need for intravenous immunoglobulin replacement therapy (IVIG) were evaluated. An audit of patients receiving rituximab for any condition in a 12-month period and frequency of hypogammaglobulinaemia was also carried out.Results: We identified 19 post-rituximab patients with persistent, symptomatic panhypogammaglobulinaemia. Mean IgG level was 3.42 +/- 0.4 g/l (normal range 5.8-16.3 g/l). All patients had reduced or absent B-cells. Haemophilus Influenzae B, tetanus and Pneumococcal serotype-specific antibody levels were all reduced and patients failed to mount an immune response post-vaccination. Nearly all of them ultimately required IVIG. The mean interval from the last rituximab dose and need for IVIG was 36 months (range 7 months-7 years). Of note, 23.7% of 114 patients included in the audit had hypogammaglobulinaemia.Conclusion: With the increasing use of rituximab, it is important for clinicians treating these patients to be aware of hypogammaglobulinaemia and serious infections occurring even years after completion of treatment and should be actively looked for during follow-up. Referral to clinical immunology services and, if indicated, initiation of IVIG should be considered.