The risk factors and treatment of rituximab-induced interstitial pneumonia in patients with diffuse large B-cell lymphoma receiving R-CDOP regimen
10.3781/j.issn.1000-7431.2023.2211-0782
- VernacularTitle:R-CDOP方案使用后利妥昔单抗相关间质性肺炎的风险因素及治疗
- Author:
Feng LI
1
;
Xuli WANG
;
Qian ZHAO
;
Qing YAN
;
Yongping ZHAI
Author Information
1. 东部战区总医院血液病科,江苏 南京 210002
- Keywords:
Diffuse large B-cell lymphoma;
R-CDOP regimen;
Rituximab;
Liposomal doxorubicin;
Interstitial pneumonia;
Corticosteroids
- From:
Tumor
2023;43(5):428-435
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To identify clinical features,possible risk factors and treatment related to rituximab-associated interstitial pneumonia(RTX-IP). Methods:The clinicopathological characteristics,immune phenotype and treatment of six patients with diffuse large B-cell lymphoma(DLBCL)develped after receiving R-CDOP treatment were retrospectively analyzed. Results:Six patients had agranulocytosis or granulocytopenia within 1 week before RTX-IP diagnosis,and the median interval time was 3 courses of treatment.All six patients had double-expressor lymphoma(DEL)or triple-expressor lymphoma(TEL).Of the six patients,four had germinal-center B-cell-like lymphoma(GCB),and two had non-GCB.The expression of Ki-67 was＞70％,except for one patient with transformed lymphoma(TL).After treatment with methylprednisolone for about 1 week,all patients'chest CT showed inflammatory absorption.However,one patient developed pneumocystis carinii pneumonia during the process of hormone reduction,and recovered after 27 days of comprehensive treatment with hormones and anti-pneumocystosis therapy.All patients received CDOP regimen(a total of 8 courses)for the treatment of the primary disease,and the process was smooth. Conclusion:R-CDOP regimen may lead to a high incidence of RTX-IP in DLBCL patients(30.0％).The DLBCL patients with DEL or TEL,GCB subtype,TL and high Ki-67 expression were more liable to develop RTX-IP,and the recovery of agranulocytosis may be related to the pathogenesis of RTX-IP.High-resolution CT scan can provide valuable evidence for early diagnosis of RTX-IP.Metagenomic next-generation sequencing(mNGS)helps to distinguish IP from pathogen infections.High dose of glucocorticoids is effective treatment strategy.At the same time,it is necessary to strengthen the prevention and treatment of infection in the process of glucocorticoids application.
