Swords R, Nolan A, Fay M, Quinn J, O'Donnell R, Murphy P T
Department of Haematology, Beaumont Hospital, Dublin, Ireland.
Clin Lab Haematol. 2006 Feb;28(1):57-9. doi: 10.1111/j.1365-2257.2006.00738.x.
A patient with cold-type autoimmune haemolytic anaemia for 8 years developed progressive B cell chronic lymphocytic leukaemia (CLL). Despite the risk of fludarabine induced exacerbation of haemolysis, he was given aggressive anti-CLL therapy with six courses of FCR (fludarabine 25 mg/m2 D1-3, cyclophosphamide 250 mg/m2 D2-4 and rituximab 375 mg/m2 D1) every 4 weeks. This resulted in a marked acute increase in haemolysis shortly after completing each course of fludarabine. However, haemolysis had settled to its baseline level by the time of subsequent courses of FCR. FCR resulted in complete clinical remission of CLL but residual haemolysis persisted. The patient was then given four weekly infusions of single agent rituximab, resulting in ongoing remission of haemolysis. In this patient, rituximab appears to have controlled fludarabine induced exacerbation of autoimmune haemolysis. In addition, subsequent single agent rituximab therapy resulted in prolonged remission of cold-type autoimmune haemolytic anaemia. It remains to be seen if the addition of rituximab will allow other patients with a positive direct Coomb's test and/or autoimmune haemolysis to receive fludarabine containing chemotherapy without undue risk of life-threatening haemolytic anaemia.
一名患有冷型自身免疫性溶血性贫血8年的患者发展为进行性B细胞慢性淋巴细胞白血病（CLL）。尽管氟达拉滨有诱发溶血加重的风险，但他每4周接受6个疗程的FCR（氟达拉滨25mg/m²第1 - 3天，环磷酰胺250mg/m²第2 - 4天，利妥昔单抗375mg/m²第1天）积极的抗CLL治疗。在完成每个氟达拉滨疗程后不久，溶血明显急性增加。然而，在后续FCR疗程时，溶血已恢复到基线水平。FCR使CLL达到完全临床缓解，但残留溶血持续存在。然后该患者接受了4周的单药利妥昔单抗输注，导致溶血持续缓解。在该患者中，利妥昔单抗似乎控制了氟达拉滨诱发的自身免疫性溶血加重。此外，后续的单药利妥昔单抗治疗使冷型自身免疫性溶血性贫血长期缓解。利妥昔单抗的加入是否能使其他直接抗人球蛋白试验阳性和/或有自身免疫性溶血的患者接受含氟达拉滨的化疗而无危及生命的溶血性贫血的不当风险，仍有待观察。
