慢性淋巴细胞白血病的抗体疗法。
Antibody therapy for chronic lymphocytic leukemia.
作者信息
Christian Beth A, Lin Thomas S
机构信息
Division of Hematology and Oncology, The Ohio State University, Columbus, OH 43210, USA.
出版信息
Semin Hematol. 2008 Apr;45(2):95-103. doi: 10.1053/j.seminhematol.2008.02.001.
The introduction of the monoclonal antibodies rituximab (anti-CD20) and alemtuzumab (anti-CD52) has revolutionized the treatment of chronic lymphocytic leukemia (CLL). Both antibodies were first studied as single agents in relapsed CLL, but rituximab is increasingly used in combination chemoimmunotherapy regimens in previously untreated patients. Phase II studies demonstrated that the addition of rituximab to fludarabine-based chemotherapy improves complete response (CR) rates and prolongs progression-free survival (PFS), but a long-term survival benefit has not been shown. Alemtuzumab is less commonly used, due to the greater likelihood of infusion toxicity, as well as hematologic and immune toxicities. Subcutaneous (SC) administration significantly reduces infusion toxicity, but hematologic and infectious complications, most notably cytomegalovirus (CMV) reactivation, still occur with SC dosing. Alemtuzumab's unique clinical properties include its clinical activity in relapsed CLL patients with del(17p13) and its ability to eradicate minimal residual disease (MRD) in bone marrow. Its use as consolidation therapy to eradicate MRD after nucleoside analog therapy is under active study. Several investigational monoclonal antibodies are in preclinical or clinical studies, most notably lumiliximab (anti-CD23) and ofatumumab (HuMax CD20), and are briefly discussed in this review.
单克隆抗体利妥昔单抗(抗CD20)和阿仑单抗(抗CD52)的引入彻底改变了慢性淋巴细胞白血病(CLL)的治疗方法。这两种抗体最初均作为单一药物用于复发性CLL的研究,但利妥昔单抗越来越多地用于初治患者的联合化疗免疫治疗方案中。II期研究表明,在基于氟达拉滨的化疗中加入利妥昔单抗可提高完全缓解(CR)率并延长无进展生存期(PFS),但尚未显示出长期生存获益。由于输注毒性以及血液学和免疫毒性的可能性更大,阿仑单抗的使用较少。皮下(SC)给药可显著降低输注毒性,但血液学和感染性并发症,最显著的是巨细胞病毒(CMV)再激活,在SC给药时仍会发生。阿仑单抗独特的临床特性包括其在伴有del(17p13)的复发性CLL患者中的临床活性以及其根除骨髓中微小残留病(MRD)的能力。其作为核苷类似物治疗后根除MRD的巩固治疗的用途正在积极研究中。几种研究性单克隆抗体正处于临床前或临床研究阶段,最显著的是鲁米利单抗(抗CD23)和奥法木单抗(HuMax CD20),本综述将对其进行简要讨论。
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