在治疗慢性淋巴细胞白血病的易布鲁替尼治疗期间发生的纯红细胞无形成症
Lei Wang1, Shishou Wu2, Guohua Yu2
1Department of Hematology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China.
概括
治疗慢性淋巴细胞白血病 (CLL) 的易布鲁替尼可能会引发自身免疫并发症,如纯红细胞无形成症 (PRCA). 用免疫抑制剂及时治疗可以恢复血红蛋白水平,并允许继续治疗CLL.
科学领域:
- 血液学 血液学 血液学
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
背景情况:
- 慢性淋巴细胞白血病 (CLL) 与免疫失调和自身免疫并发症有关.
- 易布鲁替尼改善了CLL的预后,但其在诱导自身免疫细胞衰竭 (AIC) 中的作用仍然存在争议.
研究的目的:
- 在接受ibrutinib治疗的CLL患者中报告PRCA病例.
- 讨论易布鲁替尼在CLL患者AIC发展中的潜在作用.
- 审查关于ibrutinib和AIC在CLL中的当前文献.
主要方法:
- 一名70岁的女性患有CLL和体积较大的疾病,接受了ibrutinib单一治疗.
- 患者患有严重的贫血 (Hb 37 g/L),并被诊断为PRCA.
- 治疗包括停止使用易布鲁替尼,普雷尼松,IVIg,后来使用环素A (CsA).
主要成果:
- 最初使用普得尼松和IVIg治疗并没有改善血红蛋白水平.
- 添加CsA导致Hb显著增加到92g/L,并具有高的网红细胞计数.
- 恢复了对CLL的治疗,使用Zanbrutinib,普雷尼松和CsA,实现了部分缓解.
结论:
- 这一案例凸显了在在CLL患者中启动ibrutinib之前需要评估AIC风险的必要性.
- 高风险患者可能需要暂时添加免疫抑制疗法.
- 在ibrutinib治疗CLL期间,对AIC的密切监测至关重要.
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