Objective To systematically evaluate the pharmacoeconomic vaule of chemotherapy combined with rituximab for patients with non-Hodgkin’s lymphomas (NHL). Methods A systematic literature search of cost-effectiveness studies on rituximab treating NHL published from 1998 to 2012 was carried out in following databases: PubMed, ScienceDirect, Health Technology Assessment (HTA) and Cochrane Database of Systematic Reviews (CDSR). And the references of included studies were also retrieved manually. The studies were screened according to the pre-designed inclusion and exclusion criteria, and the incremental cost- effectiveness ratio (ICER) in comparison between chemotherapy plus rituximab and chemotherapy alone was systematically evaluated according to the literature evaluation index system. Results The average ICER of Rituximab treating NHL was 16 318/QALY, 17 688/QALY, and 22 461/QALY in the UK, Mainland Europe, and US, respectively. All the reported ICERs in the included studies were below the implemented country-specific thresholds. Conclusion Based on present foreign literature, the integrated therapy of chemotherapy and rituximab for NHL is supposed to be a better cost-effective therapy with ICER below the implemented country-specific thresholds.
Objective To improve the knowledge of lung injury induced by rituximab. Methods Clinical data of 5 lymphoma patients with lung injury caused by rituximab chemotherapy were analyzed. Results Five patients received chemotherapy including rituximab, and had fever, cough and dyspnea after 3 to 5 chemotherapy cycles. Chest CT showed bilateral diffuse interstitial infiltrates. All 5 cases experienced hypoxemia or respiratory failure. Clinical symptoms were improved 3 to 5 days after the treatment of glucocorticoids, and pulmonary lesions were significantly alleviated 1 to 2 weeks after the treatment. According to the literature, the incidence rate of lung injury caused by rituximab was 0. 03% to 4. 9%, which has increased recently. Conclusions With the comprehensive application of rituximab, lung injury caused by this drug is not rare. The good prognosis depends on early diagnosis and treatment by further recognition of the side effect of rituximab.
Objective To assess the clinical effectiveness and safety of fludarabine and cyclophosphamide (FC) combined with rituximab chemotherapy regimen (FCR regimen) for patients with chronic lymphoblastic leukemia (CLL). Methods The databases such as PubMed, The Cochrane Library, SpringerLink, CNKI, and CBM were searched from 2000 to 2011. The randomized controlled trials (RCTs) on FC regimen versus FCR regimen for CLL were retrieved. The methodological quality of the included studies was assessed according to the Cochrane Reviewer’s Handbook, and meta-analyses were performed using RevMan 5.0 software. Results Three RCTs involving 1 623 patients with CLL were included. The results of meta-analyses showed that significant differences were found in the progression-free survival (PSF)(Plt;0.001), overall response (OR=1.94, 95%CI 1.49 to 2.53, Plt;0.000 01), complete remission (OR=2.54, 95%CI 2.00 to 3.22, Plt;0.000 01), and grade III or IV neutropenia (OR=1.60, 95%CI 1.33 to 1.92, Plt;0.000 01); but no significant differences were found in the partial response (OR=0.74, 95%CI 0.35 to 1.55, P=0.43), grade III or IV thrombocytopenia (OR=0.97, 95%CI 0.74 to 1.27, P=0.83) and autoimmune hemolytic anemia (OR=0.86, 95%CI 0.59 to 1.27, P=0.45) between FCR and FC regimen. Conclusion The FCR regimen can improve the progression-free survival, overall response and complete remission. Meanwhile, it sometimes increases the incidence of Grade III or IV events, such as neutropenia, thrombocytopenia, autoimmune hemolytic anemia and nausea and vomiting.
Objective To apply the evidence-based treatment method to direct the clinical therapy of refractory chronic lymphocytic leukemia (CLL). Methods Such evidence-based medicine databases as The Cochrane Library (Issue 10, 2010), OVID database, PubMed (January 1992 to October 2010) and http://www.nccn.org/ were searched to find the clinical evidence with high quality and the optimum treatment was designed based on the patient’s preferences. Results Two RCTs and five CCTs were included. The available clinical evidence displayed that rituximab could improve the therapeutic effect of combined chemotherapy on the refractory CLL, the COP/CHOP regimens were effective for the fludarabine-resistant CLL, and hematopoietic stem cell transplantation could be an effective salvage therapy for the relapsed/refractory CLL, but not the first-line recommendation drug. This patient was treated by CHOP regimen combined with rituximab, the condition of disease was improved two months after stopping chemotherapy, and the follow-up was conducted. Conclusion Current evidence reveals that rituximab combined with CHOP regimen produces good tolerance with a better clinical outcome than that of CHOP regimen. Clinical practice results display that the combination of rituximab and CHOP regimen can bring good prognosis to the patient, but still needs high-quality evidence to prove．
Objective To formulate an evidence-based treatment for a patient newly diagnosed with follicular lymphoma. Methods Based on the clinical questions we raised, evidence including systematic reviews and randomized controlled trials was collected from ACP Journal Club (1991 to November 2007), The Cochrane Library (Issue 4, 2007) and PubMed. The retrieved studies were further critically appraised. Results The addition of rituximab to chemotherapy (R-chemo) was superior to chemotherapy alone in patients with follicular lymphoma. The regimen of CVP chemotherapy plus rituximab (R-CVP) was administered to the patient. After 4 courses of R-CVP, the patient had a complete response (CR). Conclusion In newly diagnosed patients with follicular lymphoma, R-chemo is an effective treatment regimen.
ObjectiveTo summarize experience of clinical diagnosis and treatment for liver posttransplant lymphoproliferative disorder(PTLD). Method The clinical diagnosis and treatment processes of 3 patients with live PTLD in this hospital were retrospectively analyzed and the relevant literatures were reviewed. ResultsThe EB virus was negative and CD20 was positive for these 3 patients with liver PTLD, the time of onset was 10 to 12 years after liver transplantation, and the tacrolimus was given for anti-immune following liver transplantation. The pathological diagnosis was diffuse large B cell lymphoma for all the patients. ConclusionsWith use of large quantities of immunosuppressive drugs following liver transplantation, incidence of liver PTLD gradually rises. Meanwhile, prognosis is poor and early diagnosis is difficult. Currently, diagnosis and classification is still dependent on pathological examination. EB virus positive patients show earlier onset, while EB negative patients show later onset with a poorer prognosis. Therefore, a long-term follow-up should be conducted for early detection, and rituximab should be administrated to patients with CD20(+).
Immunoglobulin G4-related disease (IgG4-RD) is a new disease entity recognized at the start of this century noted to be involving many organ systems including endocrine system and thyroid in particular. It represents an immune mediated fibro inflammatory condition with characteristic histopathological appearance affecting single or multiple organs. In general, immunoglobulin G4-related thyroid disease (IgG4-RTD) is rarely considered and it may be isolated or with other organ involvement. Four subcategories of IgG4-RTD have been identified so far: Riedel thyroiditis, fibrosing variant of Hashimoto thyroiditis, immunoglobulin G4-related Hashimoto thyroiditis, and Graves disease with elevated immunoglobulin G4 levels. The diagnostic approach is complex and the work up relies on the coexistence of clinical features, histological features and serological evidence. Demonstration of the classic histopathological features is vital to diagnose IgG4-RD in most cases, and biopsy proof is preferred strongly by most disease experts before the initiation of treatment. The treatments for IgG4-RTD include medical and surgical options. Steroids are first line treatment though it may need further evaluation. Tamoxifen and rituximab are second line treatment for steroid resistant patients. Surgical excision of thyroid gland in presence of compression symptoms is the surgical option. Inspite of pathophysiology of the disease being poorly understood till now, early and prompt diagnosis and an early treatment initiation can improve the outcomes.
Rituximab (RTX) is a monoclonal antibody directed against the CD20 antigen expressed on B cells. It has been successfully employed in the treatment of non-Hodgkin's lymphoma and varied systemic autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, and granulomatosis with polyangiitis. Recently its efficacy in the treatment of ocular inflammatory diseases (OID), including refractory scleritis, peripheral ulcerative keratitis, uveitis, and ocular cicatricial pemphigoid, has aroused more concerns. The literature suggests that RTX may be useful for controlling the inflammation and decreasing or stopping the use of corticosteroids and other immunosuppressants in OID, which may contribute a new treatment alternative in patients with the recalcitrant and sight-threatening forms of OID. This article reviews the clinical application status of RTX in the treatment of OID.
ObjectiveTo observe the clinical effect of Rituximab combined with intravenous immunoglobulin (IVIG) in preventing blood group antibody mediated rejection (AMR) in pediatric ABO incompatible living donor liver transplantation (ABOi-LDLT).MethodsA total of 503 cases of pediatric living donor liver transplantation in Beijing Friendship Hospital Affiliated to Capital Medical University from June 2013 to December 2020 were retrospectively collected; the overall survival of recipient and graft were compared between ABOi-LDLT and ABO compatible living donor liver transplantation (ABOc-LDLT), and we summarized the data of AMR in 7 cases received Rituximab+IVIG protocol.ResultsThere were 53 cases of ABOi-LDLT and 450 cases of ABOc-LDLT in our study. The 5-year cumulative survival rate of recipients and grafts was 98.0% and 96.0% in the ABOi-LDLT group respectively, and in ABOc-LDLT group was 92.2% and 89.1% respectively, there was no significant difference between the two groups (P=0.232, P=0.381）. Seven children with blood group antibody titer >1∶64 were included in the study. On the basis of classical intensive immunosuppressive therapy, all patients were treated with Rituximab+IVIG. The blood group antibody titer of 6 patients remained stable, and no rejection occurred; one patient developed severe AMR and graft failure, and recovered after salvage treatment of ABOc-LDLT.ConclusionRituximab+IVIG can be used as an effective therapeutic option to prevent blood group AMR after ABOi-LDLT.
Autoimmune hemolytic anemia (AIHA) is an autoimmune disease in which the life span of red blood cells is shortened by red blood cell autoantibodies. Due to immune intolerance and abnormal immune regulation, the hyperfunction of B lymphocytes produces too many red blood cell autoantibodies. Anti-CD20 monoclonal antibody is a second-line drug for warm antibody AIHA and first-line drug for cold antibody AIHA by reducing B lymphocytes. At present, the optimal dose of anti-CD20 monoclonal antibody in the treatment of AIHA has not been determined. There are no reports on the treatment of primary AIHA with second- or third-generation anti-CD20 monoclonal antibodies.