Hematology and Stem Cell Transplantation Unit, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy.
Eur J Haematol. 2010 Dec;85(6):502-7. doi: 10.1111/j.1600-0609.2010.01527.x. Epub 2010 Nov 8.
There are no standard therapies for chronic lymphocytic leukemia (CLL)-associated immune thrombocytopenia (IT) so far.
We report the results of therapy with single agent rituximab in 21 patients with CLL-associated IT. The mean age at CLL and IT diagnosis was 64 and 68 yr, respectively. IT developed at a mean time of 44 months from the diagnosis of CLL. In four cases, IT was diagnosed at the same time as CLL. For three patients, IT was considered fludarabine-related and two patients showed autoimmune hemolysis also. All patients but one received steroids as first-line treatment for IT. Some patients received intravenous high-dose Ig, vincristine, and Cytoxan also, without beneficial effect. After a mean time of 43 d from the diagnosis of IT, all patients were scheduled to receive rituximab at a dosage of 375 mg/mq/weekly.
Eighteen (86%) patients completed the scheduled four cycles of rituximab. Irrelevant first infusion side effects were seen only in one patient. Twelve (57%) patients showed a complete response (CR), six (29%) patients a partial response (PR), and three (14%) patients did not respond. In responding patients, the mean duration of response was 21 months (4-49 months). At a mean follow-up of 28 months, 14 (66%) patients were still alive, 10 (48%) of them in CR and three (14%) in PR.
This retrospective analysis prove that rituximab is an effective and well-tolerated alternative treatment for CLL-associated IT.
目前尚无治疗慢性淋巴细胞白血病（CLL）相关免疫性血小板减少症（IT）的标准疗法。
我们报告了 21 例 CLL 相关 IT 患者接受单药利妥昔单抗治疗的结果。CLL 和 IT 的诊断平均年龄分别为 64 岁和 68 岁。IT 从 CLL 诊断到发病的平均时间为 44 个月。在 4 例中，IT 与 CLL 同时诊断。3 例 IT 被认为与氟达拉滨相关，2 例患者还出现自身免疫性溶血性贫血。所有患者除 1 例外均接受皮质类固醇作为 IT 的一线治疗。一些患者还接受了静脉注射大剂量 Ig、长春新碱和环磷酰胺治疗，但没有效果。从 IT 诊断到平均时间为 43 天后，所有患者均按每周 375mg/mq 的剂量接受利妥昔单抗治疗。
18 例（86%）患者完成了预定的 4 个周期的利妥昔单抗治疗。仅 1 例患者出现无关的首次输注副作用。12 例（57%）患者完全缓解（CR），6 例（29%）患者部分缓解（PR），3 例（14%）患者无反应。在有反应的患者中，反应的平均持续时间为 21 个月（4-49 个月）。在平均 28 个月的随访中，14 例（66%）患者仍存活，其中 10 例（48%）处于 CR，3 例（14%）处于 PR。
这项回顾性分析证明，利妥昔单抗是 CLL 相关 IT 的一种有效且耐受良好的替代治疗方法。
