低剂量利妥昔单抗治疗15例温抗体型自身免疫性溶血性贫血的疗效观察

目的观察低剂量利妥昔单抗联合地塞米松治疗15例温抗体型自身免疫性溶血性贫血的疗效及安全性。方法对2007年1月-2012年10月我院收治的15例温抗体型自身免疫性溶血性贫血（WAIHA）患者（其中1例为Evans综合征）采用以下方案进行治疗：在第1、8、15、22天给予利妥昔单抗100mg／次；给予利妥昔单抗前5d开始给予地塞米松20mg／d，共5次。结果总有效率为86．7％（13／15），中位起效时间为2个月（四分位数间距1．5个月），中位随访时间为12个月（四分位数间距4个月）。复发患者再次强化治疗仍有效。部分缓解患者抗体效价降低。1例Evans综合征患者未出现出血倾向，血小板持续维持在（90～130）×10^9／L。所有患者对该治疗方案耐受性良好，不良事件发生率低。结论低剂量利妥昔单抗联合地塞米松治疗WAIHA安全、高效。

Clinical efficacy of Rituximab in treatment of fifteen patients with warm autoimmune hemolytic anemia

Objective To observe the efficacy and safety of a monoclonal antibody, Rituximab, combined with prednisone in the treatment of warm autoimmune hemolytic anemia. Methods Fifteen patients with warm autoimmune hemolytic anemia （ including 1 case of Evans syndrome） were recruited during January, 2007 and October, 2012. Rituximab was administered at a dose of 100 mg （IV） on day 1, 8, 15 and 22, along with Dexamethasone that was administered for 5 days （20 mg per time） before the application of Rituximab. Results The overall response was 86.7% （ 13/15 ）. The median onset time was two months （with a quartile interval of 1.5 months）. The median follow-up time for the patients was 12 months （with a quartile interval of 4 months）. The treatment was still effective after the illness relapsed. The patients with partial remission had significantly lower antibody titers. The one with Evans syndrome did not showed bleeding tendency, and his platelet count was remained in （90 - 130） × 10^9/L. All of the patients were well tolerated, and the incidence of adverse events was low. Conclusion Lower dose Rituximab is an effective and safe modality for patients with warm autoimmune hemolytic anemia.