Memory B cell resurgence requires repeated rituximab in myasthenia gravis

作者：Muto Kohei; Matsui Naoko^*; Unai Yuki; Sakai Waka; Haji Shotaro; Udaka Kengo; Mild Hirokazu; Furukawa Takahiro; Abe Masahiro; Kaji Ryuji

来源：Neuromuscular Disorders, 2017, 27(10): 918-922.

DOI：10.1016/j.nmd.2017.06.012

• Myasthenia gravis
• Anti-acetylcholine receptor antibody
• Refractory
• Rituximab
• Memory B cell
• Flow cytometer

The immunologic effects of rituximab (RTX) in myasthenia gravis (MG) remain to be explored. We aimed to clarify immunologic reactions and their association with response to RTX in MG. Regulatory T cell and B cell profiles of MG patients were monitored. Two patients presenting with generalized MG with anti-acetylcholine receptor antibodies were treated with RTX. The treatment led to sustained clinical improvement, discontinuation of intravenous immunoglobulin or plasma exchange, and reduction of prednisolone and other drugs. One patient was in remission for more than one year, whereas the other patient exhibited deterioration of symptoms within one year. Disease activity was associated with the repopulation of IgD-CD27- and IgD(-)CD27(+) memory B cells. Clinicians should be aware of the possibility that MG ranges in the duration of B cell depletion and additional RTX should be prescribed upon resurgence of memory B cells.

• 出版日期2017-10