Nissen Johanna C, Hummel Margit, Brade Joachim, Kruth Jens, Hofmann Wolf-Karsten, Buchheidt Dieter, Reinwald Mark
Department of Hematology and Oncology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany.
BMC Infect Dis. 2014 Jul 3;14:364. doi: 10.1186/1471-2334-14-364.
Rituximab, a monoclonal antibody directed against CD20, is approved for the treatment of CD20-positive B-cell Non-Hodgkin's lymphoma and rheumatologic disorders. Due to its potent activity in depleting CD20-positive lymphocytes, the influence on opportunistic infections is still under discussion. Thus, we analyzed the impact of rituximab either as monotherapy or in combination with other chemotherapeutic regimens to elucidate its role in contributing to infectious complications.
The records of consecutive patients (n = 125, 141 treatment episodes) treated with rituximab alone or in combination with chemotherapy and corticosteroids were analyzed retrospectively for the incidence, spectrum and outcome of infections during treatment and 6 months after the last course of rituximab. Univariate analysis of cofactors such as steroid medication, antiinfective prophylaxis, underlying disease and remission status were performed.
Altogether 80 therapy episodes were associated with infections, the median number of infections per patient being 1 (range 1-7). The number of infectious complications was significantly higher in patients receiving a combination of rituximab and chemotherapy compared to rituximab monotherapy (p < 0.001). There was no statistically significant difference regarding number of rituximab courses or cumulative rituximab dosage between episodes with and without infections, respectively.Mean cumulative prednisone dosage between the cohort with infections and the one without infections showed a trend towards higher dosage of prednisone in the patients with infections (mean difference 441 mg, p > 0.14).
Rituximab in induction treatment, either as monotherapy or combined with chemotherapy by itself does not increase the incidence or change the spectrum of infections in hematologic patients. However the possible influence of higher dosages of concomitant steroid medication on frequency of infections suggests that a heightened awareness of the potential for infectious complications should be applied to patients receiving higher doses of glucocorticoids in combination with other therapeutic regimens.
利妥昔单抗是一种抗CD20单克隆抗体，已被批准用于治疗CD20阳性B细胞非霍奇金淋巴瘤和风湿性疾病。由于其在清除CD20阳性淋巴细胞方面的强大活性，其对机会性感染的影响仍在讨论中。因此，我们分析了利妥昔单抗单药治疗或与其他化疗方案联合使用的影响，以阐明其在导致感染并发症中的作用。
回顾性分析连续接受利妥昔单抗单药治疗或与化疗及皮质类固醇联合治疗的患者（n = 125，141个治疗疗程）的记录，以了解治疗期间及最后一个利妥昔单抗疗程后6个月内感染的发生率、范围和结局。对类固醇药物、抗感染预防、基础疾病和缓解状态等辅助因素进行单因素分析。
共有80个治疗疗程与感染相关，每位患者感染的中位数为1（范围1 - 7）。与利妥昔单抗单药治疗相比，接受利妥昔单抗与化疗联合治疗的患者感染并发症的数量显著更高（p < 0.001）。有感染和无感染的疗程之间，利妥昔单抗疗程数或利妥昔单抗累积剂量分别无统计学显著差异。感染组和未感染组之间的平均累积泼尼松剂量显示，感染患者的泼尼松剂量有升高趋势（平均差异441 mg，p > 0.14）。
利妥昔单抗在诱导治疗中，无论是单药治疗还是与化疗联合使用，本身并不会增加血液学患者感染的发生率或改变感染范围。然而，较高剂量的伴随类固醇药物对感染频率的可能影响表明，对于接受高剂量糖皮质激素与其他治疗方案联合治疗的患者，应提高对感染并发症可能性的认识。
