Department of Hematology, Oncology and Cell Therapy, Medical Center, Otto-von-Guericke University, Magdeburg, Germany.
Oncol Res Treat. 2024;47(9):434-438. doi: 10.1159/000539919. Epub 2024 Jun 21.
The development of secondary hypogammaglobulinemia (sHGG) because of tumor treatment and/or the primary underlying hematologic disorder holds substantial clinical significance. B-cell-derived malignancies and anti-CD20 monoclonal antibodies (mAbs) represent important risk factors for the development of sHGG. In addition, the occurrence of acute thrombocytopenia (AT) induced by anti-CD20 therapy is a known, albeit rare, phenomenon.
A 54-year-old patient experiencing the first relapse of classical follicular lymphoma has commenced salvage therapy following the R-DHAP protocol. After rituximab infusion, platelet count dropped from 116 × 109/L to 13 × 109/L within 24 h. Reduced immunoglobulin G levels indicated moderate HGG; thus, we immediately administered intravenous immunoglobulins (IVIg). Within 5 days after initiation of IVIg, platelet count increased and stabilized at >50 × 109/L.
It seems possible that anti-CD20 mAbs act like or activate similar mechanisms as autoantibodies in immune thrombocytopenia (ITP). Assuming that anti-CD20 therapy-induced AT is an ITP-like condition, HGG could be considered a potential risk factor. Thus, appropriate treatment of HGG with IVIg prior to anti-CD20 mAb therapy could potentially alleviate anti-CD20 therapy-induced AT.
由于肿瘤治疗和/或潜在的血液系统疾病，继发性低丙种球蛋白血症（sHGG）的发展具有重要的临床意义。B 细胞来源的恶性肿瘤和抗 CD20 单克隆抗体（mAbs）是 sHGG 发展的重要危险因素。此外，抗 CD20 治疗引起的急性血小板减少症（AT）是一种已知的、尽管罕见的现象。
一名 54 岁的患者在经历了经典滤泡淋巴瘤的首次复发后，开始接受 R-DHAP 方案的挽救治疗。利妥昔单抗输注后，血小板计数在 24 小时内从 116×109/L 降至 13×109/L。免疫球蛋白 G 水平降低表明存在中度 HGG，因此我们立即给予静脉注射免疫球蛋白（IVIg）。在开始 IVIg 治疗后的 5 天内，血小板计数增加并稳定在>50×109/L。
抗 CD20 mAbs 似乎可以像免疫性血小板减少症（ITP）中的自身抗体一样或通过类似的机制发挥作用。假设抗 CD20 治疗引起的 AT 是一种 ITP 样情况，则 HGG 可被视为潜在的危险因素。因此，在接受抗 CD20 mAb 治疗之前，用 IVIg 适当治疗 HGG 可能有助于缓解抗 CD20 治疗引起的 AT。
