Assessing complement blockade in patients with paroxysmal nocturnal hemoglobinuria receiving eculizumab

被引:132
作者
de Latour, Regis Peffault [1 ,2 ]
Fremeaux-Bacchi, Veronique [3 ,4 ]
Porcher, Raphael [5 ,6 ]
Xhaard, Alienor [1 ]
Rosain, Jeremie [3 ,4 ]
Castaneda, Diana Cadena [3 ]
Vieira-Martins, Paula [3 ,4 ]
Roncelin, Stephane [3 ]
Rodriguez-Otero, Paula [1 ]
Plessier, Aurelie [7 ]
de Fontbrune, Flore Sicre [1 ]
Abbes, Sarah [1 ]
Robin, Marie [1 ]
Socie, Gerard [1 ,8 ,9 ]
机构
[1] Hop St Louis, AP HP, Serv Hematol Greffe, F-75010 Paris, France
[2] Equipe Accueil 3518, Paris, France
[3] Hop Georges Pompidou, AP HP, Immunol Lab, Paris, France
[4] INSERM, Unite Mixte Rech Sci 1138, Cordelier Res Ctr, Team Complement & Dis, Paris, France
[5] Ctr Epidemiol Hotel Dieu, Paris, France
[6] INSERM, U1153, Paris, France
[7] Hop Beaujon, AP HP, Serv Hepatol, Clichy, France
[8] Univ Paris Diderot, Paris, France
[9] INSERM, U1160, Paris, France
关键词
HEMOLYTIC-UREMIC SYNDROME; INHIBITOR ECULIZUMAB; RENAL-TRANSPLANT; GENETIC-VARIANTS; ERYTHROCYTES; THERAPY; DEFICIENCY; ACTIVATION; MANAGEMENT; PREGNANCY;
D O I
10.1182/blood-2014-03-560540
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Paroxysmal nocturnal hemoglobinuria (PNH) is characterized by intravascular hemolysis, which is effectively controlled with eculizumab, a humanized monoclonal antibody that binds complement protein 5 (C5). The residual functional activity of C5 can be screened using a 50% hemolytic complement (CH50) assay, which is sensitive to the reduction, absence, and/or inactivity of any components of the classical and terminal complement pathway. Little data exist on complement blockade during treatment. From 2010 to 2012, clinical data, hemolysis biomarkers, complement assessment, and free eculizumab circulating levels were systematically measured immediately before every injection given to 22 patients with hemolytic PNH while receiving eculizumab therapy. During the study, 6 patients received >= 1 red blood cell transfusion. Lack of detectable CH50 activity (defined by CH50 <= 10% of normal values) was found in 184 samples (51%) and was significantly associated with lower lactate dehydrogenase levels (P = .002). Low levels of circulating free eculizumab (< 50 mu g/mL) correlated with detectable CH50 activity (CH50 > 10%; P=.004), elevated bilirubin levels (P <.0001), and the need for transfusions (P =.034). This study suggests that both CH50 activity and circulating free eculizumab levels may help physicians to manage PNH patients receiving eculizumab.
引用
收藏
页码:775 / 783
页数:9
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