利妥昔单抗治疗胸腺瘤相关及新发重症肌无力：3例病例报告及文献复习
Rituximab for the treatment of thymoma-associated and de novo myasthenia gravis: 3 cases and review.
作者信息
Nelson Robert P, Pascuzzi Robert M, Kessler Kenneth, Walsh Laurence E, Faught Phillip P, Ramanuja Srinivasan, Pescovitz Mark D, Loehrer Patrick J
机构信息
Division of Hematology/Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
出版信息
J Clin Neuromuscul Dis. 2009 Jun;10(4):170-7. doi: 10.1097/CND.0b013e31819a8403.
OBJECTIVES
Myasthenia gravis (MG) is an immune-mediated disorder associated with autoantibodies against postsynaptic nicotinic acetylcholine receptors at neuromuscular junctions. Rituximab, a monoclonal antibody specific for CD20, is used primarily to treat B-cell non-Hodgkin lymphoma. Although it has been used for treatment of a number of autoimmune diseases, there is limited experience in MG.
METHODS
Three patients with refractory MG (2 with concurrent thymoma) were given rituximab.
RESULTS
Symptoms stabilized and reductions in immunosuppressive medications were tolerated for extended periods, without adverse effects or infectious complications.
CONCLUSIONS
These observations support the concept that rituximab may be helpful for the treatment of MG. Remissions in patients with or without thymoma are achievable with rituximab given in combination with commonly used modalities. Furthermore, rituximab is not necessarily contraindicated for the treatment of MG in patients being treated for thymoma. Controlled studies are called for to define its role in the treatment of refractory MG.
目的
重症肌无力（MG）是一种免疫介导的疾病，与神经肌肉接头处针对突触后烟碱型乙酰胆碱受体的自身抗体有关。利妥昔单抗是一种针对CD20的单克隆抗体，主要用于治疗B细胞非霍奇金淋巴瘤。尽管它已被用于治疗多种自身免疫性疾病，但在MG治疗方面的经验有限。
方法
对3例难治性MG患者（2例合并胸腺瘤）给予利妥昔单抗治疗。
结果
症状稳定，免疫抑制药物用量长期减少且耐受性良好，无不良反应或感染并发症。
结论
这些观察结果支持利妥昔单抗可能有助于治疗MG这一观点。联合常用治疗方法给予利妥昔单抗，无论有无胸腺瘤的患者均可实现病情缓解。此外，对于正在接受胸腺瘤治疗的患者，利妥昔单抗治疗MG不一定是禁忌。需要进行对照研究以明确其在难治性MG治疗中的作用。
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