Bevezetés: A rituximabkezelés hatására elhúzódó B-sejt-depléció alakulhat ki, amely fokozott fertőzési kockázattal járhat. Célkitűzés: A fehérvérsejtszám, a CD19+ B- és a CD4+ T-lymphocyták számának, valamint az immunglobulin G-, A-, M-szintek változásának vizsgálata rituximabtartalmú kemoterápiában részesülő betegeknél, valamint a fertőzéses szövődmények felmérése és a vonatkozó irodalom áttekintése. Betegek és módszerek: Összesen 35 diffúz nagy B-sejtes lymphomás beteget vizsgáltak rituximab-cyclophosphamid-vincristin-doxorubicin-prednisolon (R-CHOP) terápia mellett. A perifériás vérben a B- és T-sejt-populációkat áramlási citometriával, az immunglobulin-szinteket szérum nefelometriával mérték. Eredmények: A kezelés hatására a CD19+ B-lymphocyták nem voltak kimutathatók a perifériás vérből, számuk a kezelést követő 12. hónaptól növekedett. Infekció a vizsgált betegcsoportban nem fordult elő. Következtetések: A rituximab hatására kialakuló B-sejt-depléció ebben a betegcsoportban is igazolható volt, súlyos vagy nem várt fertőzést nem tapasztaltak. Fokozott fertőzési kockázattal elsősorban (hosszabb) fenntartó rituximabkezelés mellett kell számolni. Orv. Hetil., 2012, 153, 1658–1666.
Abulayha, A. M., Tabal, S. A., Shawesh, E. I., et al.: Depletion of peripheral blood B cells with rituximab and phenotype characterization of the recovering population in a patient with follicular lymphoma. Leuk. Res., 2010, 34, 307–311.
Shawesh E. I. , 'Depletion of peripheral blood B cells with rituximab and phenotype characterization of the recovering population in a patient with follicular lymphoma ' (2010 ) 34 Leuk. Res. : 307 -311 .
Wolach, O., Bairey, O., Lahav, M.: Late-onset neutropenia after rituximab treatment. Case series and comprehensive review of the literature. Medicine, 2010, 89, 308–318.
Lahav M. , 'Late-onset neutropenia after rituximab treatment. Case series and comprehensive review of the literature ' (2010 ) 89 Medicine : 308 -318 .
Gea-Banadoche, J. C.: Rituximab-associated infections. Semin. Hematol., 2010, 47, 187–198.
Gea-Banadoche J. C. , 'Rituximab-associated infections ' (2010 ) 47 Semin. Hematol. : 187 -198 .
Kelesidis, T., Daikos, G., Boumpas, D., et al.: Does rituximab increase the incidence of infectious complications? Int. J. Inf. Dis., 2011, 15, e2–e16.
Boumpas D. , 'Does rituximab increase the incidence of infectious complications? ' (2011 ) 15 Int. J. Inf. Dis. : e2 -e16 .
Kurokawa, T., Hase, M., Tokuman, N., et al.: Immune reconstitution of B-cell lymphoma patients receiving CHOP-based chemotherapy containing rituximab. Hematol. Oncol., 2011, 29, 5–9.
Tokuman N. , 'Immune reconstitution of B-cell lymphoma patients receiving CHOP-based chemotherapy containing rituximab ' (2011 ) 29 Hematol. Oncol. : 5 -9 .
Anolik, J. H., Friedberg, J. W., Zheng, B., et al.: B cell reconstitution after rituximab treatment of lymphoma recapitulates B cell ontogeny. Clin. Immunol., 2007, 122, 139–145.
Zheng B. , 'B cell reconstitution after rituximab treatment of lymphoma recapitulates B cell ontogeny ' (2007 ) 122 Clin. Immunol. : 139 -145 .
Irie, E., Shirota, Y., Suzuki, C., et al.: Severe hypogammaglobulinemia persisting for 6 years after treatment with rituximab combined chemotherapy due to arrest of B lymphocyte differentiation together with alteration of T lymphocyte homeostasis. Int. J. Hematol., 2010, 91, 501–508.
Suzuki C. , 'Severe hypogammaglobulinemia persisting for 6 years after treatment with rituximab combined chemotherapy due to arrest of B lymphocyte differentiation together with alteration of T lymphocyte homeostasis ' (2010 ) 91 Int. J. Hematol. : 501 -508 .
Carbone, J., del Pozo, N., Gallego, A., et al.: Immunological risk factors for infection after immunosuppressive and biologic therapies. Expert Rev. Anti Infect. Ther., 2011, 9, 405–413.
Gallego A. , 'Immunological risk factors for infection after immunosuppressive and biologic therapies ' (2011 ) 9 Expert Rev. Anti Infect. Ther. : 405 -413 .
Nishio, M., Fujimoto, K., Yamamoto, S., et al.: Hypogammaglobulinemia with a selective delayed recovery in memory B cells and an impaired isotype expression after rituximab administration as an adjuvant to autologous stem cell transplantation for non-Hodgkin lymphoma. Eur. J. Hematol., 2006, 77, 226–232.
Yamamoto S. , 'Hypogammaglobulinemia with a selective delayed recovery in memory B cells and an impaired isotype expression after rituximab administration as an adjuvant to autologous stem cell transplantation for non-Hodgkin lymphoma ' (2006 ) 77 Eur. J. Hematol. : 226 -232 .
Wilk, E., Witte, T., Marquardt, N., et al.: Depletion of functionally active CD20+ T cells by rituximab treatment. Arthritis Rheum., 2009, 60, 3563–3571.
Marquardt N. , 'Depletion of functionally active CD20+ T cells by rituximab treatment ' (2009 ) 60 Arthritis Rheum. : 3563 -3571 .
Lund, F. E., Hollifield, M., Schuler, K., et al.: B cells are required for generation of protective effector and memory CD4 cells in response to Pneumocystis lung infection. J. Immunol., 2006, 176, 6147–6154.
Schuler K. , 'B cells are required for generation of protective effector and memory CD4 cells in response to Pneumocystis lung infection ' (2006 ) 176 J. Immunol. : 6147 -6154 .
Ratanatharathorn, V., Pavletic, S., Uberti, J. P.: Clinical application of rituximab in allogenic stem cell transplantation: anti-tumor and immunomodulatory effects. Cancer Treat. Rev., 2009, 35, 653–661.
Uberti J. P. , 'Clinical application of rituximab in allogenic stem cell transplantation: anti-tumor and immunomodulatory effects ' (2009 ) 35 Cancer Treat. Rev. : 653 -661 .
Nitta, E., Izutsu, K., Sato, T., et al.: A high incidence of late-onset neutropenia following rituximab-containing chemotherapy as a primary treatment of CD20-positive B-cell lymphoma: a single-institution study. Ann. Oncol., 2007, 18, 364–369.
Sato T. , 'A high incidence of late-onset neutropenia following rituximab-containing chemotherapy as a primary treatment of CD20-positive B-cell lymphoma: a single-institution study ' (2007 ) 18 Ann. Oncol. : 364 -369 .
Kimby, E.: Tolerability and safety of rituximab (MabThera). Cancer Treat. Rev., 2005, 31, 456–473.
Kimby E. , 'Tolerability and safety of rituximab (MabThera) ' (2005 ) 31 Cancer Treat. Rev. : 456 -473 .
Lanini, S., Molloy, A. C., Fine, P. E., et al.: Risk of infection in patients with lymphoma receiving rituximab: systematic review and meta-analysis. BMC Med., 2011, 9, 36.
Fine P. E. , 'Risk of infection in patients with lymphoma receiving rituximab: systematic review and meta-analysis ' (2011 ) 9 BMC Med. : 36 -.
Aksoy, S., Dizdar, O., Hayran, M., et al.: Infectious complications of rituximab in patients with lymphoma during maintenance therapy: a systematic review and meta-analysis. Leuk. Lymphoma, 2009, 50, 357–365.
Hayran M. , 'Infectious complications of rituximab in patients with lymphoma during maintenance therapy: a systematic review and meta-analysis ' (2009 ) 50 Leuk. Lymphoma : 357 -365 .
Vidal, L., Gafter-Gvili, A., Leibovici, L., et al.: Rituximab as maintenance therapy for patients with follicular lymphoma. Cochrane Database Syst. Rev., 2009, 2, CD006552.
Leibovici L. , 'Rituximab as maintenance therapy for patients with follicular lymphoma ' (2009 ) 2 Cochrane Database Syst. Rev. : CD006552 -.
Salles, G., Seymour, J. F., Offner, F., et al.: Rituximab maintenance for 2 years in patients with high tumour burden follicular lymphoma responding to rituximab plus chemotherapy (PRIMA): a phase 3, randomised controlled trial. Lancet, 2011, 377, 42–51.
Offner F. , 'Rituximab maintenance for 2 years in patients with high tumour burden follicular lymphoma responding to rituximab plus chemotherapy (PRIMA): a phase 3, randomised controlled trial ' (2011 ) 377 Lancet : 42 -51 .
Kaplan, L. D., Lee, J. Y., Ambinder, R. F., et al.: Rituximab does not improve clinical outcome in a randomized phase 3 trial of CHOP with or without rituximab in patients with HIV-associated non-Hodgkin lymphoma: AIDS-Malignancies Consortium Trial 010. Blood, 2005, 106, 1538–1543.
Ambinder R. F. , 'Rituximab does not improve clinical outcome in a randomized phase 3 trial of CHOP with or without rituximab in patients with HIV-associated non-Hodgkin lymphoma: AIDS-Malignancies Consortium Trial 010 ' (2005 ) 106 Blood : 1538 -1543 .
Carroll, M. B.: The impact of biologic response modifiers on hepatitis B virus infection. Expert Opin. Biol. Ther., 2011, 11, 533–544.
Carroll M. B. , 'The impact of biologic response modifiers on hepatitis B virus infection ' (2011 ) 11 Expert Opin. Biol. Ther. : 533 -544 .
Ohishi, W., Chayama, K.: Prevention of hepatitis B virus reactivation in immunosuppressive therapy or chemotherapy. Clin. Exp. Nephrol., 2011, 15, 634–640.
Chayama K. , 'Prevention of hepatitis B virus reactivation in immunosuppressive therapy or chemotherapy ' (2011 ) 15 Clin. Exp. Nephrol. : 634 -640 .
Francisci, D., Falcinelli, F., Schiaroli, E., et al.: Management of hepatitis B virus reactivation in patients with hematological malignancies treated with chemotherapy. Infection, 2010, 38, 58–61.
Schiaroli E. , 'Management of hepatitis B virus reactivation in patients with hematological malignancies treated with chemotherapy ' (2010 ) 38 Infection : 58 -61 .
Saag, K., Teng, G. G., Patkar, N. M., et al.: American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum., 2008, 59, 762–784.
Patkar N. M. , 'American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis ' (2008 ) 59 Arthritis Rheum. : 762 -784 .
Weissert, R.: Progressive multifocal leukoencephalopathy. J. Neuroimmunol., 2011, 231, 73–77.
Weissert R. , 'Progressive multifocal leukoencephalopathy ' (2011 ) 231 J. Neuroimmunol. : 73 -77 .
Berger, J. R.: Progressive multifocal leukoencephalopathy and newer biological agents. Drug Saf., 2010, 33, 969–983.
Berger J. R. , 'Progressive multifocal leukoencephalopathy and newer biological agents ' (2010 ) 33 Drug Saf. : 969 -983 .
Tuccori, M., Focosi, D., Blandizzi, C., et al.: Inclusion of rituximab in the treatment protocols for non-Hodgkin’s lymphomas and risk for progressive multifocal leukoencephalopathy. Oncologist, 2010, 15, 1214–1219.
Blandizzi C. , 'Inclusion of rituximab in the treatment protocols for non-Hodgkin’s lymphomas and risk for progressive multifocal leukoencephalopathy ' (2010 ) 15 Oncologist : 1214 -1219 .
Kamel, S., O’Connor, S., Lee, N., et al.: High incidence of Pneumocystis jirovecii pneumonia in patients receiving biweekly rituximab and cyclophosphamide, adriamycin, vincristine, and prednisone. Leuk. Lymphoma, 2010, 51, 797–801.
Lee N. , 'High incidence of Pneumocystis jirovecii pneumonia in patients receiving biweekly rituximab and cyclophosphamide, adriamycin, vincristine, and prednisone ' (2010 ) 51 Leuk. Lymphoma : 797 -801 .
Hugle, B., Solomon, M., Harvey, E., et al.: Pneumocystis jiroveci pneumonia following rituximab treatment in Wegener’s granulomatosis. Arthritis Care Res. (Hoboken), 2010, 62, 1661–1664.
Harvey E. , 'Pneumocystis jiroveci pneumonia following rituximab treatment in Wegener’s granulomatosis ' (2010 ) 62 Arthritis Care Res. (Hoboken) : 1661 -1664 .
Tadmor, T., McLaughlin, P., Polliack, A.: A resurgence of Pneumocystis in aggressive lymphoma treated with R-CHOP-14: the price of a dose-dense regimen? Leuk. Lymphoma, 2010, 51, 737–738.
Polliack A. , 'A resurgence of Pneumocystis in aggressive lymphoma treated with R-CHOP-14: the price of a dose-dense regimen? ' (2010 ) 51 Leuk. Lymphoma : 737 -738 .
Van Assen, S., Elkayam, O., Agmon-Levin, N., et al.: Vaccination in adult patients with auto-immune inflammatory rheumatic diseases: A systematic literature review for the European League Against Rheumatism evidence-based recommendations for vaccination in adult patients with auto-immune inflammatory rheumatic diseases. Autoimmun. Rev., 2011, 10, 341–352.
Agmon-Levin N. , 'Vaccination in adult patients with auto-immune inflammatory rheumatic diseases: A systematic literature review for the European League Against Rheumatism evidence-based recommendations for vaccination in adult patients with auto-immune inflammatory rheumatic diseases ' (2011 ) 10 Autoimmun. Rev. : 341 -352 .
Takata, T., Suzumiya, J., Ishikawa, T., et al.: Attenuated antibody reaction for the primary antigen but not for the recall antigen of influenza vaccination in patients with non-Hodgkin B-cell lymphoma after the administration of rituximab-CHOP. J. Clin. Exp. Hematopathol., 2009, 49, 9–13.
Ishikawa T. , 'Attenuated antibody reaction for the primary antigen but not for the recall antigen of influenza vaccination in patients with non-Hodgkin B-cell lymphoma after the administration of rituximab-CHOP ' (2009 ) 49 J. Clin. Exp. Hematopathol. : 9 -13 .
Bedognetti, D., Zoppoli, G., Massucco, C., et al.: Impaired response to influenza vaccine associated with persistent memory B cell depletion in non-Hodgkin’s lymphoma patients treated with rituximab-containing regimens. J. Immunology, 2011, 186, 6044–6055.
Massucco C. , 'Impaired response to influenza vaccine associated with persistent memory B cell depletion in non-Hodgkin’s lymphoma patients treated with rituximab-containing regimens ' (2011 ) 186 J. Immunology : 6044 -6055 .
Yri, O. E., Torfoss, D., Hungnes, O., et al.: Rituximab blocks protective serological response to influenza A(H1N1) 2009 vaccination in lymphoma patients during or within 6 months after treatment. Blood, 2011, 118, 6769–6771.
Hungnes O. , 'Rituximab blocks protective serological response to influenza A(H1N1) 2009 vaccination in lymphoma patients during or within 6 months after treatment ' (2011 ) 118 Blood : 6769 -6771 .
Centkowski, P., Brydak, L., Machala, M., et al.: Immunogenicity of influenza vaccination in patients with non-Hodgkin lymphoma. J. Clin. Immunol., 2007, 27, 339–346.
Machala M. , 'Immunogenicity of influenza vaccination in patients with non-Hodgkin lymphoma ' (2007 ) 27 J. Clin. Immunol. : 339 -346 .