Ganzemueller J, Hartmann B, Keller F, Stracke S
Department of Nephrology, School of Medicine, University of Ulm, Ulm, Germany.
Minerva Urol Nefrol. 2011 Dec;63(4):263-72.
Rituximab is increasingly being used in the treatment of patients with kidney disease. We evaluated our clinical experience at the Ulm University Hospital.
Since 2004, we have administered rituximab as rescue therapy to twenty-seven patients with kidney disease non-responsive to standard treatment. Indications for rituximab were progressive loss of kidney function in thirteen cases; nephrotic syndrome in five cases; humoral rejection after kidney transplantation in five cases and single cases of catastrophic antiphospholipid syndrome (CAPS), pre-emptive removal of ABO incompatible antibodies, pre-transplant removal of panel-reactive antibodies (PRA), and post-transplant lymphoproliferative disease (PTLD). Sixteen patients were treated with both, plasmapheresis and rituximab.
Kidney function recovered in five of thirteen cases. Nephrotic syndrome response was observed in two of five cases. In two of five patients with humoral rejection, kidney transplant function could be preserved. Antiphospholipid antibodies, blood group A antibodies and panel reactive antibodies successfully were reduced, and remission was achieved in the case of the patient with PTLD. Four patients died (15%). Adverse events (N.=10) and infectious complications (N.=15) were most likely due to immunosuppression in general and not to rituximab alone. Toxic leukoencephalopathy was a serious but reversible complication in three cases and occurred particularly after the administration of high-dose rituximab (>375 mg/m2).
Rituximab rescue was successful in 48% of our cases (13 of 27). Rituximab did not increase the complication risk of standard immunosuppression. But toxic leukoencephalopathy was identified as a significant rituximab complication.
利妥昔单抗越来越多地用于治疗肾病患者。我们评估了在乌尔姆大学医院的临床经验。
自2004年以来，我们将利妥昔单抗作为挽救疗法应用于27例对标准治疗无反应的肾病患者。使用利妥昔单抗的指征包括：13例患者肾功能进行性丧失；5例患者患有肾病综合征；5例患者肾移植后发生体液排斥反应，还有个别患者分别患有灾难性抗磷脂综合征（CAPS）、术前清除ABO血型不相容抗体、移植前清除群体反应性抗体（PRA）以及移植后淋巴细胞增生性疾病（PTLD）。16例患者同时接受了血浆置换和利妥昔单抗治疗。
13例患者中有5例肾功能恢复。5例肾病综合征患者中有2例有反应。5例体液排斥反应患者中有2例肾移植功能得以保留。抗磷脂抗体、A型血抗体和群体反应性抗体成功降低，PTLD患者实现缓解。4例患者死亡（15%）。不良事件（n = 10）和感染并发症（n = 15）很可能总体上是由于免疫抑制，而非仅由利妥昔单抗导致。毒性白质脑病在3例患者中是一种严重但可逆的并发症，尤其在大剂量（>375 mg/m²）使用利妥昔单抗后发生。
在我们的病例中，48%（27例中的13例）利妥昔单抗挽救治疗成功。利妥昔单抗未增加标准免疫抑制的并发症风险。但毒性白质脑病被确定为利妥昔单抗的一种重要并发症。
