Unit of Translational Medicine, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki 852-8102, Japan.
Department of Rheumatology, Japan Community Health care Organization, Isahaya General Hospital, Isahaya 854-8501, Japan.
Clin Immunol. 2016 Apr;165:35-7. doi: 10.1016/j.clim.2016.03.005. Epub 2016 Mar 4.
We treated a 45-year-old Japanese woman with primary Sjogren's syndrome (SS) complicated with dermatomyositis (DM) followed by diffuse large B-cell lymphoma. She was admitted to our hospital for further evaluation of fever, weight loss and peritoneal lymphadenopathy. The histological examination of her lymph node revealed diffuse large B-cell lymphoma. The patient was then treated with 8 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) therapy, which resulted in histological and functional improvement of her salivary glands. Of note, the percentage of effector memory Th17-1 (CD3+CD4+CD45RA-CCR7-CXCR3+CCR6+) cells in the peripheral blood was decreased after the R-CHOP treatment. This case suggests that an altered Th17-1 cell subset by B-cell depletion therapy is critical for the improvement of tissue damage in patients with SS, and the case suggests that clinicians should consider measuring the effector memory Th-subsets to predict the disease activity in SS patients.
我们治疗了一位 45 岁的日本女性，她患有原发性干燥综合征（SS）并发皮肌炎（DM），随后发展为弥漫性大 B 细胞淋巴瘤。她因发热、体重减轻和腹膜淋巴结病而入院，进一步评估。淋巴结的组织学检查显示弥漫性大 B 细胞淋巴瘤。随后，患者接受了 8 个周期的 R-CHOP（利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松）治疗，这导致她的唾液腺组织学和功能得到改善。值得注意的是，R-CHOP 治疗后外周血中效应记忆 Th17-1（CD3+CD4+CD45RA-CCR7-CXCR3+CCR6+）细胞的比例下降。该病例提示 B 细胞耗竭治疗改变 Th17-1 细胞亚群对改善 SS 患者的组织损伤至关重要，并提示临床医生应考虑测量效应记忆 Th 亚群以预测 SS 患者的疾病活动。
