Serum sickness with an elevated level of human anti-chimeric antibody following treatment with rituximab in a child with chronic immune thrombocytopenic purpura
Serum sickness with an elevated level of human anti-chimeric antibody following treatment with rituximab in a child with chronic immune thrombocytopenic purpura
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DOI：
10.1007/s12185-009-0269-6
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发表时间：
2009-04-01
影响因子：
2.1
通讯作者：
Kai, Sumio
中科院分区：
文献类型：
--
作者：
Goto, Shoko;Goto, Hiroaki;Kai, Sumio
利妥昔单抗是一种嵌合的鼠/人单克隆抗CD 20抗体，已被批准用于治疗B细胞淋巴瘤，并已显示出对自身免疫性疾病如免疫性血小板减少性紫癜（ITP）的疗效。相对安全;然而，据报道，约1-20%的患者发生了利妥昔单抗诱导的血清病，这在自身免疫性疾病患者中比在恶性血液病患者中更常见。在这里，我们描述了一个儿童患者类固醇依赖性慢性ITP谁提出了关节痛和发热后10天的第二次输注利妥昔单抗（第10天），并提出了不适和斑丘疹在第21天。开始口服泼尼松龙，症状消退。在第27天，他的人抗嵌合抗体（HACA）水平升高;此后，HACA水平缓慢下降。据我们所知，在接受利妥昔单抗治疗慢性ITP的儿科患者中，这是第六例血清病的记录病例，也是唯一一例表现出HACA水平升高的病例。利妥昔单抗是一种有益的治疗选择，对慢性ITP;但是，血清病的风险应予以考虑。类固醇通常用于治疗血清病，在利妥昔单抗治疗期间和之后使用类固醇可以预防严重血清病的发展。
Rituximab, a chimeric murine/human monoclonal anti-CD20 antibody, was licensed for the treatment of B-cell lymphoma and has also shown efficacy against autoimmune diseases such as immune thrombocytopenic purpura (ITP). It is relatively safe; however, about 1-20% of patients were reported to have developed rituximab-induced serum sickness, which is more common among patients with autoimmune conditions than among those with hematologic malignancies. Here we describe a pediatric patient with steroid-dependent chronic ITP who presented with arthralgia and fever ten days after the second infusion of rituximab (on day 10), and presented with malaise and maculopapular rash on day 21. Oral prednisolone was started and his symptoms resolved. He had an elevated level of human anti-chimeric antibody (HACA) on day 27; thereafter, the HACA level slowly decreased. To our knowledge, among pediatric patients who received rituximab for chronic ITP, this is the sixth documented case of serum sickness and the only one who manifested an elevated level of HACA. Rituximab is a beneficial treatment option against chronic ITP; however, the risk of serum sickness should be considered. Steroid, usually used for the treatment of serum sickness, may prevent the development of severe serum sickness when administered during and after rituximab treatment.