Autoimmune hemolytic anemia
Autoimmune hemolytic anemia
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DOI：
10.1111/j.1365-2796.2009.02126.x
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发表时间：
2009-11-01
影响因子：
11.1
通讯作者：
Delannoy, A.
中科院分区：
文献类型：
--
作者：
Dierickx, D.;Verhoef, G.;Delannoy, A.
目的：为了更好地表征抗CD20治疗的效果，我们分析了利妥昔单抗在比利时患有自身免疫性溶血性贫血(AIHA)和免疫性血小板减少性紫癜(ITP)的患者中的使用情况。设计：我们对比利时使用利妥昔单抗治疗的AIHA和ITP患者进行了回顾性的多中心分析。对53例AIHA患者和40例ITP患者的68个疗程的利妥昔单抗治疗进行了分析。干预、有效率、有效时间和预测疗效的因素进行了评估。结果：所有患者在至少一个先前的治疗失败后接受了利妥昔单抗治疗，其中AIHA和ITP患者中分别有19%和72.5%的患者接受了脾切除术。AIHA和ITP的总有效率分别为79.2%和70%，自首次应用利妥昔单抗以来，AIHA和ITP的中位随访期分别为15个 月(0.5~62个月)和11个 月(0~74个月)。 组1、2年无进展生存率分别为72%、56%和70%、44%。在这项回顾分析中，我们不能确定预测利妥昔单抗疗效的预处理特征。9名AIHA患者和3名ITP患者接受了一个或多个额外疗程的利妥昔单抗治疗。这些患者中，大多数对以前的疗程有反应，无论是在质量上还是在反应持续时间上，都经历了与以前的相似的新反应。最后，利妥昔单抗治疗无效的患者在后续治疗的反应和生存方面的结果都很差。结论：本研究证实利妥昔单抗在大多数既往治疗的AIHA和ITP患者中都能诱导反应。响应持续时间一般超过1 年。在有反应的患者中，利妥昔单抗再次治疗通常是成功的。服用利妥昔单抗失败的患者结果很差。我们不能确定治疗前患者的特征，以预测疗效。
Objectives.For better characterizing the effect of anti‐CD20 therapy, we analysed the use of rituximab in Belgian patients experiencing auto‐immune haemolytic anaemia (AIHA) and immune thrombocytopenic purpura (ITP).Design.We performed a retrospective multicentric analysis of patients with AIHA and ITP treated with rituximab in Belgium.Setting.Haematological departments were invited to fill in a questionnaire about patient and disease characteristics.Subjects.All patients with AIHA and ITP, both primary and secondary to other diseases, who received one or more courses of rituximab during their disease course were included. Sixty‐eight courses of rituximab in 53 patients with AIHA and 43 courses in 40 patients with ITP were analyzed.Intervention.Response rates, duration of response and factors predictive for response were assessed.Results.All patients were given rituximab after failing at least one previous line of treatment, including splenectomy in 19% and 72.5% of AIHA‐patients and ITP‐patients respectively. Overall response rates were 79.2% in AIHA and 70% in ITP, with a median follow‐up since first rituximab administration of 15 months (range 0.5–62) in AIHA and 11 months (range 0–74) in ITP. Progression free survival at 1 and 2 years were 72% and 56% in AIHA and 70% and 44% in ITP. In this retrospective analysis we were not able to identify pretreatment characteristics predictive for response to rituximab. Nine patients with AIHA and three patients with ITP were given one or more additional courses of rituximab. Most of these patients, who had responded to a previous course, experienced a new response comparable to the previous one, both in terms of quality and of duration of response. Finally, the outcome of patients who failed to respond to rituximab therapy was poor both in terms of response to subsequent therapy and in terms of survival.Conclusions.This study confirms that rituximab induces responses in a majority of previously treated patients with AIHA and ITP. Response duration generally exceeds 1 year. Retreatment with rituximab in responding patients is most often successful. The outcome of patients who fail on rituximab is poor. We were not able to identify pretreatment patient characteristics predicting for response.