Department of Haematology, Imperial Health Care Trust, London, UK.
Br J Haematol. 2010 Apr;149(1):3-13. doi: 10.1111/j.1365-2141.2010.08076.x. Epub 2010 Feb 11.
Depletion of B lymphocytes using the anti-CD20 monoclonal antibody rituximab has wide-spread use in the treatment of patients with autoimmune disorders. As haematopoietic progenitor cells and only a fraction of differentiated plasma express CD20, the effect of rituximab on immune function appears to be minimal. However, hypogammagobulinaemia can occur with repeated doses and emerging data from large studies suggest a subtle increase in the risk of infection. Reactivation of latent JC virus, resulting in progressive multifocal leucoencephalopathy, and hepatitis B virus, resulting in hepatoxicity, have been documented in patients receiving rituximab; although confounding effects of concomitant immunosuppressive therapies and immune dysregulation due to the underlying disease make causal associations of infections problematic. This review discusses the efficacy of B cell depletion therapy in the treatment of autoimmune diseases, the effect of B cell depletion on infection and immunity including the role of the B cell in autoimmunity, and identifies areas of controversy.
使用抗 CD20 单克隆抗体利妥昔单抗耗竭 B 淋巴细胞在治疗自身免疫性疾病患者中得到广泛应用。由于造血祖细胞和仅一部分分化的浆细胞表达 CD20，利妥昔单抗对免疫功能的影响似乎很小。然而，重复剂量可导致低丙种球蛋白血症，并且来自大型研究的新数据表明感染风险略有增加。接受利妥昔单抗治疗的患者中已记录到潜伏的 JC 病毒（导致进行性多灶性白质脑病）和乙型肝炎病毒（导致肝毒性）的再激活；尽管由于潜在疾病导致的伴随免疫抑制治疗的混杂影响和免疫失调使得感染的因果关联成为问题。这篇综述讨论了 B 细胞耗竭疗法在治疗自身免疫性疾病中的疗效、B 细胞耗竭对感染和免疫的影响，包括 B 细胞在自身免疫中的作用，并确定了存在争议的领域。
