Kalac Matko, Kolonić Slobodanka Ostojić, Kardum-Skelin Ika, Planinc-Peraica Ana, Siftar Zoran, Jaksić Branimir
Interna klinika Medicinskog fakulteta u Zagrebu, Klinicka bolnica Merkur, Zagreb, Hrvatska.
Acta Med Croatica. 2007 Sep;61(4):425-7.
A 63 year old woman with non-Hodgkin lymphoma presented with unilateral pleural effusion, which when aspirated revealed CD19 and CD20 positive malignant cells. Prior to this, the patient had received several lines of chemotherapy (CHOP, VAD, FED) with no effect on pleural effusion. Repeated percutaneous drainage procedures were unable to control the effusion either. Rituximab was therefore instilled in a dose escalating manner via repeated pleurocenteses. Fifty days after the application of rituximab, pleural effusion was still present but reduced in size. Flow cytometry and immunocytochemistry performed on the same day showed CD19 positive cells which were lacking CD20 epitope, which could be explained by either engagement or destruction of the CD20 epitope upon interaction with rituximab making the detection of the CD20 molecule impossible by routine flow cytometry. What is especially interesting is the fact that even 50 days after the application of rituximab intrapleurally no new CD20 positive cells could be found in the pleural effusion by immunochemistry or flow cytometry, opening an interesting issue concerning the length of rituximab's activity when applied locally. Although our patient had no adverse effects, further analysis of rituximab's activity and safety when applied intrapleurally is warranted.
一名63岁的非霍奇金淋巴瘤女性患者出现单侧胸腔积液，胸腔穿刺抽液显示为CD19和CD20阳性的恶性细胞。在此之前，该患者已接受多线化疗（CHOP、VAD、FED），但对胸腔积液均无效果。反复的经皮引流操作也无法控制积液。因此，通过反复胸腔穿刺以剂量递增的方式注入利妥昔单抗。应用利妥昔单抗50天后，胸腔积液仍然存在，但体积减小。同一天进行的流式细胞术和免疫细胞化学显示CD19阳性细胞缺乏CD20表位，这可能是由于与利妥昔单抗相互作用时CD20表位被结合或破坏，使得通过常规流式细胞术无法检测到CD20分子。特别有趣的是，即使在胸腔内应用利妥昔单抗50天后，通过免疫化学或流式细胞术在胸腔积液中也未发现新的CD20阳性细胞，这引发了一个关于局部应用利妥昔单抗时其活性持续时间的有趣问题。尽管我们的患者没有出现不良反应，但仍有必要进一步分析胸腔内应用利妥昔单抗时的活性和安全性。
