Rituximab therapy for chonic and refractory immune thrombocytopenic purpura

Dátum: 30.10.2009 17:03
Vec: Trombocytopenia

Rituximab therapy for chonic and refractory immune thrombocytopenic purpura: a long-term follow-up analysis

Jaime Garcia-Chavez & Abraham Majluf-Cruz & Laura Montiel-Cervantes & Miriam García-Ruiz Esparza & Jorge Vela-Ojeda & The Mexican Hematology Study Group

(1) Departamento de Hematología, UMAE “Dr. Antonio Fraga Mouret”, Hospital de Especialidades CMN “La Raza”, Mexico City, Mexico
(2) Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Hospital General Regional Gabriel Mancera, Instituto Mexicano del Seguro Social, Apartado postal 12-1100, Mexico City, México 12 DF, Mexico

Annals of Hematology (2007) 86:871–877

Keywords Chronic ITP. Rituximab . Anti-CD20 . Refractory ITP

Abstract The aim of this study was to evaluate the long-term response to rituximab in patients with chronic and refractory immune thrombocytopenic purpura (ITP). Adults with ITP fail to respond to conventional therapies in almost 30% of cases, developing a refractory disease. Rituximab has been successfully used in these patients. We used rituximab at 375 mg/m2, IV, weekly for a total of four doses in 18 adult patients. Complete remission (CR) was considered if the platelet count was >100 × 109/l, partial remission (PR) if platelets were >50 × 109/l, minimal response (MR) if the platelet count was >30 × 109/l and <50 × 109/l, and no response if platelet count remained unchanged. Response was classified as sustained (SR) when it was stable for a minimum of 6 months. Median age was 43.5 years (range, 17 to 70). Median platelet count at baseline was 12.5 × 109/l (range, 3.0 to 26.3). CR was achieved in five patients (28%), PR in five (28%), MR in four (22%), and two patients were classified as therapeutic failures (11%). Two additional patients were lost to follow-up. The median time between rituximab therapy and response was 14 weeks (range, 4 to 32). SR was achieved in 12 patients (67%). There were no severe adverse events during rituximab therapy. During follow-up (median, 26 months; range, 12 to 59), no other immunosuppressive drugs were used. In conclusion, rituximab therapy is effective and safe in adult patients with chronic and refractory ITP. Overall response rate achieved is high, long term, and with no risk of adverse events.

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