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目的探讨小剂量利妥昔单抗治疗继发于结缔组织疾病(CTD)血小板减少症(TP)序贯维持的临床疗效及安全性。方法选择16例继发于CTD的重症TP患者,给予利妥昔单抗100mg静脉滴注,每周1次,连用4周;动态观察血常规变化,采用流式细胞术检测治疗前、后CD3+、CD19+CD20+淋巴细胞数,免疫比浊法定量检测治疗前、后血清免疫球蛋白(IgG、lgM、IgA)水平。治疗有效患者序贯给予每6个月静脉滴注利妥昔单抗100mg行维持治疗,通过长期随访评价维持治疗有效性。结果治疗后7例(43.75%)达完全缓解(CR),4例(25.00%)达有效(R),总有效率为68.75%,5例(31.25%)无效(NR)。患者利妥昔单抗治疗前、后血清免疫球蛋白及CD3+淋巴细胞数比较差异无统计学意义(P>0.05),但CD19+CD20+淋巴细胞数较治疗前明显下降(P<0.01),并达到清除水平。11例治疗有效患者接受了维持治疗,CR的7例患者均未复发,4例R患者中有2例在维持治疗期间获得CR,1例维持R,1例复发。4例发生轻度输液反应,1例发生肺炎,抗感染治疗后治愈。结论小剂量利妥昔单抗治疗继发于CTD的TP安全有效,而对治疗有效的患者序贯维持治疗能有效减少复发。
Objective To investigate the clinical efficacy and safety of low-dose rituximab in the sequential maintenance of thrombocytopenia (TP) secondary to connective tissue disease (CTD). Methods Sixteen patients with severe TP secondary to CTD were enrolled in this study. Rituximab 100 mg was given intravenously once a week for 4 weeks. The changes of blood routine were observed dynamically. Flow cytometry was used to detect CD3 + , The number of CD19 + CD20 + lymphocytes and the level of serum immunoglobulin (IgG, lgM, IgA) before and after treatment by immunoturbidimetry. Effective treatment of patients with sequential intravenous infusion of rituximab every 6 months 100mg line maintenance treatment, long-term follow-up evaluation of maintenance treatment effectiveness. Results After treatment, complete remission was achieved in 7 cases (43.75%), effective (R) in 4 cases (25.00%), total effective rate was 68.75%, and 5 cases (31.25%) were ineffective. There was no significant difference in serum immunoglobulin and CD3 + lymphocyte count between before and after treatment with rituximab (P> 0.05), but the number of CD19 + CD20 + lymphocytes was significantly lower than before treatment (P <0.01) Achieve clearance level. Of the 11 patients who received effective maintenance therapy, none of the 7 patients with CR relapsed, 2 of 4 patients with R who received CR during maintenance, 1 who sustained R, and 1 who relapsed. 4 cases of mild infusion reaction, 1 case of pneumonia, anti-infective therapy cured. Conclusions Low dose rituximab is safe and effective in the treatment of TP secondary to CTD, while sequential maintenance therapy in patients with effective treatment can effectively reduce recurrence.