Cooper Nichola, Evangelista Maria Laura, Amadori Sergio, Stasi Roberto
Molecular Immunology Unit, Institute of Child Health, London, UK.
Curr Opin Hematol. 2007 Nov;14(6):642-6. doi: 10.1097/MOH.0b013e3282c8ca50.
The anti-CD20 monoclonal antibody rituximab has been used to treat patients with chronic immune thrombocytopenic purpura. This review discusses whether the optimal timing for this therapy is before splenectomy, or after failure of splenectomy.
No study has directly compared rituximab to splenectomy in patients with chronic immune thrombocytopenic purpura. Rituximab produces an initial response in approximately 60% of cases, with no significant difference between splenectomized and nonsplenectomized patients. Long-term complete responses are observed in 15-20% of cases. Adverse events related to the drug were usually mild or moderate, with a low incidence of infections. Long-term safety data, however, are still lacking. Deaths have been reported for 2.9% of immune thrombocytopenic purpura cases treated with rituximab, but they could not be attributed to the study drug.
Both the response rate and the response duration appear lower following rituximab than following splenectomy. Although the side effects may be fewer, there is insufficient evidence to support the replacement of splenectomy with rituximab as a second-line treatment of chronic immune thrombocytopenic purpura outside a clinical trial. At the present time, the use of immunotherapy before splenectomy can be recommended only in patients at high risk for splenectomy and in those not willing to undergo surgery.
抗CD20单克隆抗体利妥昔单抗已用于治疗慢性免疫性血小板减少性紫癜患者。本综述讨论了该治疗的最佳时机是在脾切除术前还是脾切除术后失败时。
尚无研究直接比较利妥昔单抗与脾切除术治疗慢性免疫性血小板减少性紫癜患者的疗效。利妥昔单抗在大约60%的病例中产生初始反应，脾切除患者和未脾切除患者之间无显著差异。15%-20%的病例观察到长期完全缓解。与药物相关的不良事件通常为轻度或中度，感染发生率较低。然而，长期安全性数据仍然缺乏。接受利妥昔单抗治疗的免疫性血小板减少性紫癜病例中有2.9%报告死亡，但不能归因于研究药物。
利妥昔单抗治疗后的缓解率和缓解持续时间似乎低于脾切除术。虽然副作用可能较少，但在临床试验之外，没有足够的证据支持用利妥昔单抗替代脾切除术作为慢性免疫性血小板减少性紫癜的二线治疗。目前，仅在脾切除高风险患者和不愿接受手术的患者中推荐在脾切除术前使用免疫疗法。
