鞘内注射利妥昔单抗治疗异基因造血干细胞移植后中枢神经系统淋巴细胞增殖性疾病

摘要

目的 评估鞘内注射利妥昔单抗治疗EB病毒(EBV)相关性中枢神经系统(CNS)移植后淋巴细胞增殖性疾病(CNS-PTLD)的疗效及安全性.方法 将2008年8月至2012年5月以静脉注射利妥昔单抗为基础治疗无效的4例CNS-PTLD患者纳入评估,采用剂量递增法鞘内注射利妥昔单抗.结果 对4例在初始静脉注射利妥昔单抗为基础治疗7～11d后疾病进展的患者加用鞘内注射利妥昔单抗治疗,经3～6次治疗后,4例患者均获得缓解.4例患者共接受21次鞘内注射利妥昔单抗,其中2例患者分别在第3次(30 mg利妥昔单抗)和第4次(40 mg利妥昔单抗)鞘内注射后出现短暂头痛、双下肢麻木,这些表现在24h内能自行缓解.结论 采用剂量递增方式鞘内注射利妥昔单抗治疗静脉注射利妥昔单抗为基础治疗无效的CNS-PTLD是安全有效的.%Objective To evaluate the curative effect and safety of intrathecal rituximab for EpsteinBarr virus (EBV)-associated post-transplant lymphoproliferative disorder (PTLD) with central nervous system (CNS) involvement.Methods Four CNS-PTLD patients who had failed to the intravenous rituximab-based treatments were enrolled.Intrathecal rituximab was administrated weekly of the sequential dose-escalation schedule.Results For the 4 patients who failed to the intravenous rituximab-based treatments,intrathecal rituximab was used on 7-11 days after the initial treatments.After 3-6 times of intrathecal rituximab,the 4 patients all obtained complete remission.Two of the 4 patients experienced transient headache,numbness of lower limbs immediately after intrathecal administration of 30 mg or 40 mg rituximab.These symptoms alleviated within 24 hours.Conclusion The administration of dose-escalation intrathecal rituximab is feasible and effective to CNS-PTLD patients who had failed to the intravenous rituximab-based treatments.