The Korean Journal of Medicine

  • 제87권3호
  • /
  • Pages.357-362
  • /
  • 2014
  • /
  • 1738-9364(pISSN)
  • /
  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

림프종 환자에서 리툭시맙 치료 후에 발생한 저감마글로불린혈증 1예

A Case of Prolonged Hypogammaglobulinemia after Rituximab-Containing Chemotherapy in a Patient with Lymphoma

  • 노현진 (가톨릭대학교 의과대학 내과학교실) ;
  • 공봉한 (가톨릭대학교 의과대학 내과학교실) ;
  • 김영신 (가톨릭대학교 의과대학 내과학교실) ;
  • 정윤화 (가톨릭대학교 의과대학 내과학교실) ;
  • 우인숙 (가톨릭대학교 의과대학 내과학교실) ;
  • 한치화 (가톨릭대학교 의과대학 내과학교실)
  • Noh, Hyun Jin (Departments of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Gong, Bong Han (Departments of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kim, Young Sin (Departments of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Jung, Yun Hwa (Departments of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Woo, In Sook (Departments of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Han, Chi Wha (Departments of Internal Medicine, The Catholic University of Korea College of Medicine)
  • 투고 : 2013.02.25
  • 심사 : 2013.11.11
  • 발행 : 2014.09.01
⟨ 이전 논문 다음 논문 ⟩

초록

저자들은 B세포림프종 환자에서 rituximab이 포함된 항암치료 후 2년 이상 지속된 저감마글로불린혈증을 경험하였기에 문헌고찰과 함께 보고한다.

Rituximab, an anti-CD20 monoclonal antibody, is an effective target agent against the B lymphocytes in B-cell lymphoid malignancies and various lymphoproliferative diseases. Moreover, the toxicity of rituximab is less severe than that of conventional cytotoxic agents, which has promoted the widespread application of rituximab in the treatment of B-cell lymphoma. However, depletion of B lymphocytes by rituximab, which leads to secondary hypogammaglobulinemia, can cause deterioration of humoral immunity. Although immune reconstitution after hematopoietic stem cell transplantation is known to prevent prolonged hypogammaglobulinemia, very few cases of long-standing hypogammaglobulinemia have been reported. We report herein a case of prolonged hypogammaglobulinemia after rituximab-containing chemotherapy and splenectomy in a patient with non-Hodgkin's lymphoma and discuss the clinical significance and pathogenetic mechanism of this phenomenon with a literature review.

키워드

참고문헌

  1. Walewski J, Kraszewska E, Mioduszewska O, et al. Rituximab (Mabthera, Rituxan) in patients with recurrent indolent lymphoma: evaluation of safety and efficacy in a multicenter study. Med Oncol 2001;18:141-148. https://doi.org/10.1385/MO:18:2:141
  2. Anolik JH, Friedberg JW, Zheng B, et al. B cell reconstitution after rituximab treatment of lymphoma recapitulates B cell ontogeny. Clin Immunol 2007;122:139-145. https://doi.org/10.1016/j.clim.2006.08.009
  3. Avanzini MA, Locatelli F, Dos Santos C, et al. B lymphocyte reconstitution after hematopoietic stem cell transplantation: functional immaturity and slow recovery of memory CD27+ B cells. Exp Hematol 2005;33:480-486. https://doi.org/10.1016/j.exphem.2005.01.005
  4. Hicks LK, Woods A, Buckstein R, et al. Rituximab purging and maintenance combined with auto-SCT: long-term molecular remissions and prolonged hypogammaglobulinemia in relapsed follicular lymphoma. Bone Marrow Transplant 2009;43:701-708. https://doi.org/10.1038/bmt.2008.382
  5. Kurokawa T, Hase M, Tokuman N, Yoshida T. Immune reconstitution of B-cell lymphoma patients receiving CHOP-based chemotherapy containing rituximab. Hematol Oncol 2011;29:5-9. https://doi.org/10.1002/hon.947
  6. Abulayha AM, Tabal SA, Shawesh EI, 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. https://doi.org/10.1016/j.leukres.2009.06.005
  7. Nishio M, Endo T, Fujimoto K, et al. FCGR3A-158V/F polymorphism may correlate with the levels of immunoglobulin in patients with non-Hodgkin's lymphoma after rituximab treatment as an adjuvant to autologous stem cell transplantation. Eur J Haematol 2009;82:143-147. https://doi.org/10.1111/j.1600-0609.2008.01174.x
  8. Capolunghi F, Rosado MM, Sinibaldi M, Aranburu A, Carsetti R. Why do we need IgM memory B cells? Immunol Lett 2013;152:114-120. https://doi.org/10.1016/j.imlet.2013.04.007
  9. Walker AR, Kleiner A, Rich L, et al. Profound hypogammaglobulinemia 7 years after treatment for indolent lymphoma. Cancer Invest 2008;26:431-433. https://doi.org/10.1080/07357900701809068
  10. Casulo C, Maragulia J, Zelenetz AD. Incidence of hypogammaglobulinemia in patients receiving rituximab and the use of intravenous immunoglobulin for recurrent infections. Clin Lymphoma Myeloma Leuk 2013;13:106-111. https://doi.org/10.1016/j.clml.2012.11.011

피인용 문헌

  1. The Use of Rituximab with Immune Tolerance Induction Therapy for Hemophilia A with Inhibitors vol.22, pp.1, 2014, https://doi.org/10.15264/cpho.2015.22.1.67