吕慧娟①, 董玲①, 李维①, 侯芸①, 宋拯①, 李兰芳①, 邱立华①, 钱正子①, 周世勇①, 刘贤明①, 王华庆②, 张会来①, 付凯①. 利妥昔单抗相关间质性肺炎的临床分析[J]. 中国肿瘤临床, 2016, 43(7): 291-297. DOI: 10.3969/j.issn.1000-8179.2016.07.284
引用本文: 吕慧娟①, 董玲①, 李维①, 侯芸①, 宋拯①, 李兰芳①, 邱立华①, 钱正子①, 周世勇①, 刘贤明①, 王华庆②, 张会来①, 付凯①. 利妥昔单抗相关间质性肺炎的临床分析[J]. 中国肿瘤临床, 2016, 43(7): 291-297. DOI: 10.3969/j.issn.1000-8179.2016.07.284
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Huijuan LV1, Ling DONG1, Wei LI1, Yun HOU1, Zheng SONG1, Lanfang LI1, Lihua QIU1, Zhengzi QIAN1, Shiyong ZHOU1, Xianming LIU1, Huaq-ing WANG2, Huilai ZHANG1, Kai FU1. Clinical analysis of rituximab-induced interstitial pneumonia[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2016, 43(7): 291-297. DOI: 10.3969/j.issn.1000-8179.2016.07.284
Citation: Huijuan LV1, Ling DONG1, Wei LI1, Yun HOU1, Zheng SONG1, Lanfang LI1, Lihua QIU1, Zhengzi QIAN1, Shiyong ZHOU1, Xianming LIU1, Huaq-ing WANG2, Huilai ZHANG1, Kai FU1. Clinical analysis of rituximab-induced interstitial pneumonia[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2016, 43(7): 291-297. DOI: 10.3969/j.issn.1000-8179.2016.07.284
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利妥昔单抗相关间质性肺炎的临床分析

Clinical analysis of rituximab-induced interstitial pneumonia

    摘要
  • 摘要: 目的：分析B 细胞非霍奇金淋巴瘤（B cell non-Hodgkin's lymphoma ，B-NHL）患者行化疗或免疫化疗后发生间质性肺炎（interstitial pneumonia ，IP ）与美罗华（利妥昔单抗注射液）的相关性，并分析IP 发生的临床特征。方法：回顾性分析天津医科大学肿瘤医院2010年1 月至2015年5 月期间266 例初治CD20+B-NHL患者的病例资料，将所有病例分为美罗华联合化疗组和单纯化疗组，分析IP 的发生与美罗华使用之间的关系，及其相关的临床特点。结果：化疗联合美罗华组中IP 的发生率9.6%（13/ 135）较单纯化疗组2.3%（3/ 131）高（P < 0.05），与IP 发生相关的临床特征包括老年、男性、初诊时淋巴细胞计数高于正常值、既往糖尿病史、病理亚型为弥漫性大B 细胞性淋巴瘤（diffuse large B-cell lymphoma，DLBCL ）；淋巴细胞绝对值超过正常范围（HR= 14.685，95%CI：3.137～63.234，P = 0.001）、糖尿病（HR= 8.811，95%CI：1.907～40.720，P = 0.005）、病理亚型为DLBCL （HR= 0.078，95%CI：0.012～0.489，P = 0.006）及美罗华的使用（HR= 6.769，95%CI：1.359～33.710，P = 0.020）是其发生的独立危险因素。多数患者无明显症状，不需要特殊处理。结论：美罗华可导致IP 的发生，可能与免疫力的降低及真菌感染相关，激素冲击疗法联合或不联合抗真菌治疗能取得良好的疗效。

     

    Abstract: A clinical study was conducted on 266 cases of CD 20+ B- NHL patients with CHOP- like or RCHOP- like therapeutic regimen from January 2010to May 2015. The cases were divided into rituximab-containing chemotherapy group and chemotherapy group. We analyzed the relationship between the development of IP and the use of rituximab. The IP related clinical features were also reviewed. Results:The incidence of IP in the rituximab-containing chemotherapy group was significantly higher compared with the incidence in the chemotherapy group. The IP- related factors include age> 60, male, elevated absolute lymphocyte count (ALC), diabetes, and dif-fuse larpe B- cell lymphoma (DLBCL) subtype. By multivariate analysis, elevated ALC, diabetes, DLBCL subtype, and addition of ritux -imab were revealed as significant factors for an elevated risk of IP. Conclusion: The incidence of IP was higher in patients with CD20+ B-NHL receiving rituximab-containing chemotherapy ; this result may be related to immune disorders. Corticosteroids and antifungal ther-apy can effectively relieve the patients' symptoms.

     

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