Immune anaemias in patients with chronic lymphocytic leukaemia treated with fludarabine, cyclophosphamide and rituximab - incidence and predictors
Immune anaemias in patients with chronic lymphocytic leukaemia treated with fludarabine, cyclophosphamide and rituximab - incidence and predictors
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DOI：
10.1111/j.1365-2141.2007.06513.x
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发表时间：
2007-03-01
影响因子：
6.5
通讯作者：
Keating, Michael J.
中科院分区：
文献类型：
--
作者：
Borthakur, Gautam;O'Brien, Susan;Keating, Michael J.
免疫性贫血（IA）[自身免疫性溶血性贫血（AIHA）和纯红细胞发育不全（PRCA）]是慢性淋巴细胞白血病（CLL）的并发症。氟达拉滨与AIHA相关，而利妥昔单抗和环磷酰胺均已用于治疗该病症。这些药物与氟达拉滨合用可降低AIHA的可能性。我们报告了300例接受氟达拉滨、环磷酰胺和利妥昔单抗（FCR）治疗的患者IA的发生率、结局和预处理预测因素。19例（6.5%）发展为IA [AIHA]（5.5%）。8%), prca（0%）。（7%）]在FCR治疗期间或之后。大多数AIHA患者（82.4%）直接抗球蛋白试验（DAT）阴性。其他溶血指标（间接高胆红素血症、网状红细胞缺血症、低接触珠蛋白和乳酸脱氢酶水平升高）证实了这些患者中AIHA的存在。大多数患者对类固醇、环孢素、静脉注射免疫球蛋白等治疗有反应。高预处理水平的β -2微球蛋白预测IA的发展。在FCR之前，8例AIHA患者在FCR治疗期间未观察到溶血危机。因此，在接受FCR治疗的CLL患者中，IA的发生率与历史发生率相当。即使DAT为阴性，也可考虑诊断AIHA。预先存在的AIHA不需要排除一线FCR治疗。
Immune anaemias (IA) [auto-immune haemolytic anaemia (AIHA) and pure red cell aplasia (PRCA)] are complications of chronic lymphocytic leukaemia (CLL). Fludarabine has been associated with AIHA, whereas both rituximab and cyclophosphamide have been used to treat this condition. Combining these agents with fludarabine may reduce the likelihood of AIHA. We report on the incidence, outcome and pretreatment predictors of IA in 300 patients treated with fludarabine, cyclophosphamide and rituximab (FCR). Nineteen patients (6(.)5%) developed IA [AIHA (5(.)8%), PRCA (0(.)7%)] on or after treatment with FCR. Most patients (82(.)4%) with AIHA had a negative direct antiglobulin test (DAT). Additional markers of haemolysis (indirect hyperbilirubinaemia, reticulocytosis, low haptoglobin and elevated lactate dehydrogenase levels) confirmed the presence of AIHA in these patients. The majority of patients responded to therapies including steroids, ciclosporin, i.v. immunoglobulin, etc. High pretreatment levels of beta-2 microglobulin predicted for development of IA. No haemolytic crisis was observed during FCR therapy in eight patients with AIHA prior to FCR. Thus, the incidence of IA among CLL patients treated with FCR was comparable with historical rates. The diagnosis of AIHA can be considered even if the DAT is negative. Pre-existing AIHA need not preclude front-line FCR therapy.