a Division of Internal Medicine, Medical School , University of Ioannina , Ioannina , Greece.
b Department of Translational Medical Sciences , Federico II University , Naples , Italy.
Int Rev Immunol. 2017 Nov 2;36(6):352-359. doi: 10.1080/08830185.2017.1346092. Epub 2017 Aug 11.
Rituximab (RTX) is a monoclonal antibody against CD20, commonly used in the treatment of hematological malignancies and autoimmune diseases. The use of RTX is related to the development of hypogammaglobulinemia and infections. Aim of this review is to summarize the evidence supporting the association of specific risk factors with the development of hypogammaglobulinemia and infections post-RTX. Immunological complications are more common in patients with malignant diseases as compared to non-malignant diseases. Moreover, the use of more than one dose of RTX, maintenance regimens, low pre-treatment basal immunoglobulin levels and the association with Mycophenolate and purine analogues represent risk factors for the development of hypogammaglobulinemia. The number of RTX courses, the evidence of low IgG levels for more than 6 months, the use of G-CSF, the occurrence of chronic lung disease, cardiac insufficiency, extra-articular involvement in patients with rheumatoid arthritis, low levels of IgG and older age have been correlated with a higher risk of infections. Even though the heterogeneity of the studies in terms of study population age and underlying disease, RTX schedules as well as differences in pre-treatment or concomitant therapy doesn't allow drawing definitive conclusions, the study of the literature highlight the association of specific risk factors with the occurrence of hypogammaglobulinemia and/or infections. A long term randomized controlled clinical trial could be useful to define a personalized evidence-based risk management plan for patients treated with RTX.
利妥昔单抗（RTX）是一种针对 CD20 的单克隆抗体，常用于治疗血液系统恶性肿瘤和自身免疫性疾病。RTX 的使用与低丙种球蛋白血症和感染的发生有关。本综述的目的是总结支持特定危险因素与 RTX 后低丙种球蛋白血症和感染发生相关的证据。与非恶性疾病相比，恶性疾病患者更常发生免疫并发症。此外，使用超过一剂 RTX、维持方案、治疗前基础免疫球蛋白水平低以及与霉酚酸和嘌呤类似物的关联是发生低丙种球蛋白血症的危险因素。RTX 疗程数、IgG 水平持续低 6 个月以上、使用 G-CSF、慢性肺病、心功能不全、类风湿关节炎患者关节外受累、IgG 水平低和年龄较大与感染风险增加相关。尽管研究在研究人群年龄和基础疾病、RTX 方案以及治疗前或同时治疗方面存在异质性，但不能得出明确的结论，文献研究强调了特定危险因素与低丙种球蛋白血症和/或感染的发生之间的关联。长期随机对照临床试验可能有助于为接受 RTX 治疗的患者制定基于个体化证据的风险管理计划。
