Webster Duncan, Ritchie Bruce, Mant Michael J
Department of Medicine, University of Alberta and University of Alberta Hospital, Edmonton, Alberta, Canada.
Am J Hematol. 2004 Apr;75(4):258-9. doi: 10.1002/ajh.20034.
A 71-year-old male with severe autoimmune hemolysis with both cold agglutinins and warm antibodies was intolerant of prednisone and cyclophosphamide. Rituximab was given during a 60-day period when he required 41 units of packed cells to maintain hemoglobin above 75 g/l. Two weeks later hemoglobin stabilized at 95 g/l, and further transfusions were not required. A second course of rituximab was given 4 months later for continued hemolysis. A satisfactory hemoglobin was maintained for 9 months from initial treatment, when hemoglobin again fell to 65 g/L. A prompt response to a third course of rituximab was obtained. This is the second patient with both cold agglutinins and warm antibodies with severe hemolytic anemia who has had a prompt response to rituximab. This treatment should be considered when a rapid response is needed or when a patient has failed to respond to more standard therapies.
一名71岁男性患有严重的自身免疫性溶血，同时存在冷凝集素和温抗体，对泼尼松和环磷酰胺不耐受。在60天内，当他需要41单位的红细胞悬液来维持血红蛋白高于75 g/l时，给予了利妥昔单抗。两周后，血红蛋白稳定在95 g/l，不再需要进一步输血。4个月后，因持续溶血给予了第二个疗程的利妥昔单抗。从初始治疗开始，血红蛋白维持在满意水平达9个月，之后血红蛋白再次降至65 g/L。对第三个疗程的利妥昔单抗迅速产生了反应。这是第二例同时存在冷凝集素和温抗体且患有严重溶血性贫血的患者，对利妥昔单抗迅速产生了反应。当需要快速反应或患者对更标准的治疗无反应时，应考虑这种治疗方法。
