zabmedvestnikЗабайкальский медицинский вестникTransbaikalian Medical Bulletin1998-6173Читинская государственная медицинская академия10.52485/19986173_2025_2_106zabmedvestnik-285Research ArticleНАУЧНЫЕ ОБЗОРЫSCIENTIFIC REVIEWSЗакономерности развития иммунных осложнений у больных лимфопролиферативными заболеваниями, получающих терапию ритуксимабомPatterns of development of immune complications in patients with lymphoproliferative diseases receiving rituximab therapyhttps://orcid.org/0009-0003-0856-6690ЛогвиненкоД. П.LogvinenkoD. P.

Дмитрий Петрович Логвиненко, врач клинической лабораторной диагностики, аспирант

кафедра гематологии и трансфузиологии с курсом клинической лабораторной диагностики, генетики и лабораторной генетики

344022; пер. Нахичеванский 29; Ростов-на-Дону

Doctor of Clinical Laboratory Diagnostics. Postgraduate student

Department of Hematology and Transfusiology with a course in Clinical Laboratory Diagnostics, Genetics and Laboratory Genetics

344022; 29 Nakhichevan Sky.; Rostov-on-Don

d795149318@yandex.ruhttps://orcid.org/0000-0003-2246-2858ШатохинЮ. В.ShatokhinYu. V.

Юрий Васильевич Шатохин, д. м. н., профессор, заведующийотделением

кафедра гематологии и трансфузиологии с курсом клинической лабораторной диагностики, генетики и лабораторной генетики; отделение гематологии

344022; пер. Нахичеванский 29; Ростов-на-Дону

Doctor of Medical Sciences, Professor, Head of the Department

Department of Hematology and Transfusiology with a Course of Clinical Laboratory Diagnostics, Genetics and Laboratory Genetics; Hematology Department

344022; 29 Nakhichevan Sky.; Rostov-on-Don

shatokhin-yv@yandex.ruhttps://orcid.org/0000-0003-2074-777XНагорнаяГ. Ю.NagornayaG. Yu.

Галина Юрьевна Нагорная, к. м. н., доцент

кафедра гематологии и трансфузиологии с курсом клинической лабораторной диагностики, генетики и лабораторной генетики, заведующая лабораторией

КДЛ

344022; пер. Нахичеванский 29; Ростов-на-Дону

Сandidate of Medical Sciences, Associate Professor, Head of the Laboratory

Department of Hematology and Transfusiology with a Course of Clinical Laboratory Diagnostics, Genetics and Laboratory Genetics; Clinical Diagnostic Laboratory

344022; 29 Nakhichevan Sky.; Rostov-on-Don

g.nagornaya@inbox.ruhttps://orcid.org/0000-0002-3286-3930ДегтереваЕ. В.DegterevaE. V.

Елена Валентиновна Дегтерева, к. м. н., доцент

кафедра гематологии и трансфузиологии с курсом клинической лабораторной диагностики, генетики и лабораторной генетики

344022; пер. Нахичеванский 29; Ростов-на-Дону

Сandidate of Medical Sciences, Associate Professor

Department of Hematology and Transfusiology with a Course of Clinical Laboratory Diagnostics, Genetics and Laboratory Genetics

344022; 29 Nakhichevan Sky.; Rostov-on-Don

degtereva_ev@rostgmu.ruФГБОУ ВО «Ростовский государственный медицинский университет» Министерства здравоохранения РФРоссияRostov State Medical UniversityRussian Federation20250407202502106119Copyright © Логвиненко Д.П., Шатохин Ю.В., Нагорная Г.Ю., Дегтерева Е.В., 20252025Логвиненко Д.П., Шатохин Ю.В., Нагорная Г.Ю., Дегтерева Е.В.Logvinenko D.P., Shatokhin Y.V., Nagornaya G.Y., Degtereva E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.zabmedvestnik.ru/jour/article/view/285

   Ритуксимаб – синтетическое (генно-инженерное) химерное моноклональное антитело, которое заняло свою нишу применения не только в отношении лимфопролиферативных заболеваний (неходжскинских лимфом и хронического лимфолейкоза), но и в отношении ряда других заболеваний. Однако при применении данного препарата возникает ряд осложнений, в том числе иммунных. Выявлена определенная закономерность развития иммунных осложнений в зависимости от этапа терапии. На протяжении терапии ритуксимабом часто регистрируются случаи транзиторного снижения В-лимфоцитов или уровня иммуноглобулинов, которые нивелируются через 6–12 месяцев после окончания лечения данным препаратом. Также описывается развитие длительной и стойкой нейтропении, развивающейся отсрочено по отношению к окончанию терапии. Выделяют факторы риска, ассоциирующиеся с иммунологическими осложнениями: мужской пол, европеоидная раса, возраст старше 50 лет, иммунокомпрометированные состояния (иммуносупрессивная терапия, первичные и вторичные иммунодефициты). К наиболее эффективным методам профилактики относят: выявление тяжелых инфекционных осложнений в последние 6 месяцев наблюдения за пациентами, выявление критического снижения уровня иммуноглобулинов класса G (менее 4 г/л) и его коррекция методом иммунозаместительной терапии, определение содержания в периферической крови зрелых В-лимфоцитов и проведение профилактической санации очагов хронической инфекции.

   Rituximab is a synthetic (genetically engineered) chimeric monoclonal antibody that has occupied its niche of application not only in relation to lymphoproliferative diseases (non-Hodgkin lymphomas and chronic lymphocytic leukemia), but also in relation to a number of other diseases. However, when using this drug, a number of complications occur, including immune ones. A certain pattern of development of immune complications has been revealed depending on the stage of therapy. During rituximab therapy, cases of transient decrease in B-lymphocytes or immunoglobulin levels are often reported, which are leveled 6-12 months after the end of treatment with this drug. It also describes the development of prolonged and persistent neutropenia, which develops delayed in relation to the end of therapy. There are risk factors associated with immunological complications: male gender, Caucasian race, age over 50 years, immunocompromised conditions (immunosuppressive therapy, primary and secondary immunodeficiency). The most effective methods of prevention include: detection of severe infectious complications in the last 6 months of patient follow-up, detection of a critical decrease in the level of class G immunoglobulins (less than 4 g /l) and its correction by immunosuppression therapy; determination of the content of mature B lymphocytes in peripheral blood and preventive sanitation of foci of chronic infection.

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The authors declare that there are no conflicts of interest present.