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[利妥昔单抗]

[Rituximab].

作者信息

Okamoto Rumiko, Maeda Yoshiharu, Sasaki Tsuneo

机构信息

Dept. of Chemotherapy, Tokyo Metropolitan Komagome Hospital.

出版信息

Gan To Kagaku Ryoho. 2003 Aug;30(8):1085-93.

Abstract

CHOP has been the standard chemotherapy for aggressive non-Hodgkin's lymphoma (NHL). However, indolent NHL remains largely an incurable diseases, with nearly static overall survival, and only 40% of patients with aggressive NHL are cured by CHOP. Monoclonal antibodies are an exciting advance in the treatment of lymphoma. Rituximab is a mouse/human chimeric monoclonal antibody that targets the CD20 antigen found on the surface of malignant and normal cells of the B-cell lineage, but not on primitive stem cells or mature plasma cells. Rituximab is safe and well-tolerated, and exhibit little cross-resistance with conventional chemotherapeutic agents. Clinical trials with rituximab indicate that the drug has broad application to NHL, although further clarification is needed to determine its optimal use in many of these clinical settings. In indolent NHL, rituximab has shown useful response rates, both as first-line therapy in relapsed disease. In aggressive lymphomas, diffuse large B-cell lymphoma is the most common form, the addition of rituximab to CHOP chemotherapy significantly lengthens disease-free and overall survival compared to CHOP alone as first line therapy, at least in elderly patients. These included combination with chemotherapy, prolonged or increased dosing regimens, and maintenance therapy, in which rituximab is administered to patients in remission to eliminate minimal residual disease and reduce the risk of relapse. Rituximab in vivo purging and maintenance is also being evaluated in autologous transplantation setting. Newer agents, including radiolabelled antibodies, Immunotoxin-linked antibodies and antibodies against novel target antigens are being tested in on-going clinical trial.

摘要

CHOP方案一直是侵袭性非霍奇金淋巴瘤(NHL)的标准化疗方案。然而,惰性NHL在很大程度上仍是一种无法治愈的疾病,总体生存率几乎停滞不前,且只有40%的侵袭性NHL患者通过CHOP方案得以治愈。单克隆抗体是淋巴瘤治疗领域一项令人振奋的进展。利妥昔单抗是一种鼠/人嵌合单克隆抗体,它靶向B细胞系恶性和正常细胞表面发现的CD20抗原,但不作用于原始干细胞或成熟浆细胞。利妥昔单抗安全且耐受性良好,与传统化疗药物几乎没有交叉耐药性。利妥昔单抗的临床试验表明,尽管在许多临床情况下还需要进一步明确其最佳用法,但该药物在NHL中有广泛应用。在惰性NHL中,利妥昔单抗已显示出有效的缓解率,无论是作为复发性疾病的一线治疗。在侵袭性淋巴瘤中,弥漫性大B细胞淋巴瘤是最常见的形式,与单独使用CHOP作为一线治疗相比,在CHOP化疗中加入利妥昔单抗可显著延长无病生存期和总生存期,至少在老年患者中如此。这些包括与化疗联合、延长或增加给药方案以及维持治疗,即在缓解期给患者使用利妥昔单抗以清除微小残留病灶并降低复发风险。利妥昔单抗在体内的净化和维持治疗也正在自体移植环境中进行评估。包括放射性标记抗体、免疫毒素连接抗体和针对新型靶抗原的抗体在内的新型药物正在正在进行的临床试验中进行测试。

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