Rituximab-Associated Infections
Rituximab-Associated Infections
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DOI：
10.1053/j.seminhematol.2010.01.002
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发表时间：
2010-04-01
影响因子：
3.6
通讯作者：
Gea-Banacloche, Juan C.
中科院分区：
文献类型：
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作者：
Gea-Banacloche, Juan C.
经过10多年的使用，利妥昔单抗已被证明是非常安全的。然而，现在积累的证据表明，在某些情况下，它可能会显著增加感染的风险。由于混杂因素（即同时使用免疫抑制剂或化疗药物和潜在疾病）以及报告不足，这种风险难以量化。在接受维持性利妥昔单抗治疗的低级别淋巴瘤患者和伴有严重免疫缺陷的患者中，无论是由人类免疫缺陷病毒（NW）感染还是免疫抑制剂如氟达拉滨引起的感染数量增加。从实际的角度来看，最重要的感染是乙型肝炎再激活，它可能被延迟并导致暴发性肝衰竭和死亡。应特别注意乙型肝炎病毒（HBV）筛查和先发制人的抗病毒治疗。一些调查人员报告了肺囊虫性肺炎的增加。最后，越来越多的证据表明它可能与进行性多灶性白质脑病（PML）有关，PML是一种由多瘤病毒JC引起的致死性脑炎。本综述列举了所描述的感染性并发症，总结了风险增加的可能潜在机制，并就预防、诊断和管理提出了建议。《血液学》47:187-198。(C) 2010出版的爱思唯尔公司。
After more than 10 years of use, rituximab has proven to be remarkably safe. However, accumulated evidence now suggests that under some circumstances it may significantly increase the risk of infections. This risk is difficult to quantify because of confounding factors (namely, concomitant use of immunosuppressive or chemotherapeutic agents and underlying conditions), as well as under-reporting. Increased number of infections has been documented in patients treated with maintenance rituximab for low-grade lymphoma and in patients with concomitant severe immunodeficiency, whether caused by human immunodeficiency virus (NW) infection or immunosuppressive agents like fludarabine. From the practical standpoint, the most important infection is hepatitis B reactivation, which may be delayed and result in fulminant liver failure and death. Special care should be placed on screening for hepatitis B virus (HBV) and preemptive antiviral treatment. Some investigators have reported an increase in Pneumocystis pneumonia. Finally, there is increasing evidence of a possible association with progressive multifocal leukoencephalopathy (PML), a lethal encephalitis caused by the polyomavirus JC. This review enumerates the described infectious complications, summarizes the possible underlying mechanisms of the increased risk, and makes recommendations regarding prevention, diagnosis and management. Semin Hematol 47:187-198. (C) 2010 Published by Elsevier Inc.