Ng Kien Hoe, Dearden Claire, Gruber Pascale
Department of Medicine, Royal Free London NHS Foundation Trust, London, UK.
Royal Marsden Hospital, London, UK.
BMJ Case Rep. 2015 Mar 2;2015:bcr2014208203. doi: 10.1136/bcr-2014-208203.
Rituximab is used for treatment of multiple haematological cancers. Caution for use is advised in patients with significant cardiorespiratory disease due to known cases of exacerbations of angina and arrhythmias. However, its cardiotoxicity profile is not as well recognised as other monoclonal antibodies such as transtuzumab. We report a case of a 66-year-old man who developed Takotsubo's cardiomyopathy (TC) after an elective infusion of rituximab. This case is exceptional in that rituximab has not been linked to TC, and the vast majority of chemotherapy-linked and immunotherapy-linked TC reactions have occurred during initial infusions. We also discuss the different mechanisms which link TC to immunotherapy and chemotherapy, and propose that there may be a potential for risk-stratifying recipients of this frequently used immunotherapy prior to administering treatment.
利妥昔单抗用于治疗多种血液系统癌症。由于已知有因使用利妥昔单抗而导致心绞痛和心律失常加重的病例，故建议患有严重心肺疾病的患者谨慎使用。然而，其心脏毒性特征不如曲妥珠单抗等其他单克隆抗体那样为人所熟知。我们报告了一例66岁男性患者，在择期输注利妥昔单抗后发生了Takotsubo心肌病（TC）。该病例不同寻常之处在于利妥昔单抗此前未被认为与TC有关，而且绝大多数与化疗及免疫疗法相关的TC反应都发生在初次输注期间。我们还讨论了将TC与免疫疗法和化疗联系起来的不同机制，并提出在给予这种常用免疫疗法之前，可能有对接受者进行风险分层的潜力。
