Rituksimab ile başarılı şekilde tedavi edilen immun trombositopenili kronik lenfositik lösemi: Olgu sunumu
Loading...
Date
2013-09-17
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Kronik lenfositik lösemi (KLL) klinik seyri sırasında otoimmun hastalıklarla komplike olabilmektedir. İmmun trombositopeni (İT) KLL seyrinde %2 oranında görülür. Bununla birlikte varlığı kötü prognoz ile ilişkilidir. İT ile birlikte olan KLL'nin standart bir tedavisi yoktur. Kırksekiz yaşında erkek olguya Uludağ Üniversitesi Tıp Fakültesi Hematoloji B.D.'da evre I KLL tanısı konuldu. İlk tanıda trombosit 4.810/mmᵌ idi. Birinci basamak tedavi olarak 1 mg/kg/gün dozunda steroid verildi. Yanıt alınamadı. İki gün yüksek doz İVİG (1 g/kg/gün) tedavisi uygulandı. Yine yanıt alınamadı. Sitotoksik tedavi olarak 1 kür R-CHOP kemoterapisi uygulandı. Tedavinin 3. haftasından sonra trombositler 25.000/mm³'nin altında seyretti. Bir miktar yanıtlı gördüğümüz hastamıza 1 hafta ara ile 375 mg/m²/gün dozunda toplam 4 hafta rituksimab tedavisi uygulandı. Tedavi sonunda trombosit sayısı maksimum 95.000/mmᵌ'e ulaşırken 4. doz sonrası trombosit değeri 52.900/mm³ idi. Kısmi yanıtlı kabul edildi. Biz olgumuzda rituksimab tedavisinin etkili ve iyi tolere edilen bir alternatif olduğunu düşünmek teyiz
Chronic lymphocytic leukemia (CLL) may become complicated with otoimmune diseases during it’s clinical course. Immune thrombocyto penia (IT) has a 2% prevelance in the clinical course of CLL. Also IT indicates a poor prognosis. There are no standard terapies for CLL associated IT so far. A 48-year-old male patient was diagnosed with stage I CLL at Uludag University Faculty of Medicine Hematology Department. Initial thrombocyte count during diagnosis was 4.810/mm³. He was started a 1 mg/kg/d dose of steroids regimen as a first-line therapy to which the patient did not respond. Later, for a time period of two days he was given high dose (1 g/kg/d) IVIG but again there was no response to the treatment. One course of R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin, prednisolone) chemotherapy was applied as cytotoxic treatment. Thrombocyte counts of the patient were below 25.000/mm³ after the third week of treatment. We consid ered this as limited-response and started the patient on 375 mg/m²/d dose of rituximab therapy per week for a total of four weeks. Thrombo cyte count was up to 95.000/mm³ after treatment and it was 52.900/mm³ at the end of the fourth dose of rituximab which we considered as partial-response. Therefore we believe the rituximab therapy to be efficient and well-tolerated alternative in this case.
Chronic lymphocytic leukemia (CLL) may become complicated with otoimmune diseases during it’s clinical course. Immune thrombocyto penia (IT) has a 2% prevelance in the clinical course of CLL. Also IT indicates a poor prognosis. There are no standard terapies for CLL associated IT so far. A 48-year-old male patient was diagnosed with stage I CLL at Uludag University Faculty of Medicine Hematology Department. Initial thrombocyte count during diagnosis was 4.810/mm³. He was started a 1 mg/kg/d dose of steroids regimen as a first-line therapy to which the patient did not respond. Later, for a time period of two days he was given high dose (1 g/kg/d) IVIG but again there was no response to the treatment. One course of R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin, prednisolone) chemotherapy was applied as cytotoxic treatment. Thrombocyte counts of the patient were below 25.000/mm³ after the third week of treatment. We consid ered this as limited-response and started the patient on 375 mg/m²/d dose of rituximab therapy per week for a total of four weeks. Thrombo cyte count was up to 95.000/mm³ after treatment and it was 52.900/mm³ at the end of the fourth dose of rituximab which we considered as partial-response. Therefore we believe the rituximab therapy to be efficient and well-tolerated alternative in this case.
Description
Uludağ Üniversitesi Tıp Fakültesi 9. İç Hastalıkları Kış Kongresi'nde sunulmuştur
Keywords
Kronik Lenfositik Lösemi, Rituksimab, İmmun Trombositopeni, Chronic Lymphocytic Leukemia, Immun Thrombocytopenia, Rituximab
Citation
Irmak, G. vd. (2013). "Rituksimab ile başarılı şekilde tedavi edilen immun trombositopenili kronik lenfositik lösemi: Olgu sunumu". Uludağ Üniversitesi Tıp Fakültesi Dergisi, 39(3), 177-180.