Wang Yihao, Fu Rong, Liu Hui, Wang Honglei, Zhang Tian, Ding Shaoxue, Zhang Jiangbo, Gao Shan, Liu Chunyan, Wang Jun, Xing Limin, Wang Huaquan, Li Lijuan, Liu Hong, Ruan Erbao, Song Jia, Wu Yuhong, Guan Jing, Qu Wen, Shao Zonghong
Department of Hematology, General Hospital,Tianjin Medical University,Tianjin 300052, China.
Zhonghua Xue Ye Xue Za Zhi. 2014 Aug;35(8):719-23. doi: 10.3760/cma.j.issn.0253-2727.2014.08.011.
To detect memory B lymphocyte (Bm) in peripheral blood (PB) of immune-related pancytopenia (IRP).
86 patients with IRP and 11 health volunteers were enrolled in this study. Bm (CD5⁺ CD19⁺ CD27⁺) and bone marrow mononucleated cell antibodies (BMMNC-Ab) were determined via fluorescence-activated cell sorting, and clinical outcomes of these patients were analyzed.
(1)43 initial patients achieved obvious remission in all 52 initial cases after conventional immunosuppression therapy. 16 relapsed patients with IRP received Rituximab (RTX) and 14 cases achieved obvious remission, among which 7 cases were refractory to conventional immunosuppression therapy, 5 cases exhibited obvious remission, and 2 cases did not respond. Other 18 relapsed cases received conventional immunosuppression therapy and 13 cases achieved obvious remission. (1)The level of Bm in PB in 52 initial patients with IRP was(1.81 ± 0.97)%, and no significant difference was observed between the initial patients and health volunteers (1.75 ± 0.55)% (P>0.05). The level of Bm in PB in 34 relapsed patients with IRP was obviously higher than that in the initial IRP patients and health volunteers (P<0.05). Significant difference was observed in the level of Bm in PB in 16 relapsed IRP patients between pre-therapy and post-therapy with RTX (P<0.05). No statistical difference was found between the remission and no-response groups in relapsed patients treated with RTX. RTX regimen produced more effective outcome than conventional immunosuppression therapy, which better eliminated Bm than the latter (P<0.05). Initial patients with IRP who relapsed within a two-year follow-up period had a lower level of Bm in PB compared with un-relapsed patients (P<0.05). Majority of BMMNC- Ab antibodies in relapsed patients were IgG (82.4%) and IgM (69.2%) autoantibodies in patients with initial IRP.
The level of Bm in PB was associated with relapsed patients with IRP. Bm did not respond to conventional immunosuppression therapy,but responded to RTX.
检测免疫相关性全血细胞减少症（IRP）患者外周血中的记忆B淋巴细胞（Bm）。
本研究纳入86例IRP患者和11名健康志愿者。通过荧光激活细胞分选法检测Bm（CD5⁺CD19⁺CD27⁺）和骨髓单个核细胞抗体（BMMNC-Ab），并分析这些患者的临床结局。
（1）52例初诊患者经传统免疫抑制治疗后，43例获得明显缓解。16例复发的IRP患者接受利妥昔单抗（RTX）治疗，14例获得明显缓解，其中7例对传统免疫抑制治疗耐药，5例获得明显缓解，2例无效。另外18例复发患者接受传统免疫抑制治疗，13例获得明显缓解。（1）52例初诊IRP患者外周血中Bm水平为（1.81±0.97）%，初诊患者与健康志愿者（1.75±0.55）%之间无显著差异（P>0.05）。34例复发IRP患者外周血中Bm水平明显高于初诊IRP患者和健康志愿者（P<0.05）。16例复发IRP患者RTX治疗前后外周血中Bm水平有显著差异（P<0.05）。RTX治疗复发患者的缓解组与无效组之间无统计学差异。RTX方案比传统免疫抑制治疗更有效，其清除Bm的效果优于后者（P<0.05）。在两年随访期内复发的初诊IRP患者外周血中Bm水平低于未复发患者（P<0.05）。复发患者中大多数BMMNC-Ab抗体为IgG（82.4%），初诊IRP患者中为IgM（69.2%）自身抗体。
外周血中Bm水平与IRP复发患者相关。Bm对传统免疫抑制治疗无反应，但对RTX有反应。
