Dexamethasone plus rituximab yields higher sustained response rates than dexamethasone monotherapy in adults with primary immune thrombocytopenia

Zaja, Francesco; Baccarani, Michele; Mazza, Patrizio; Bocchia, Monica; Gugliotta, Luigi; Zaccaria, Alfonso; Vianelli, Nicola; Defina, Marzia; Tieghi, Alessia; Amadori, Sergio; Campagna, Selenia; Ferrara, Felicetto; Angelucci, Emanuele; Usala, Emilio; Cantoni, Silvia; Visani, Giuseppe; Fornaro, Antonella; Rizzi, Rita; Stefano, Valerio De; Casulli, Francesco; Battista, Marta Lisa; Isola, Miriam; Soldano, Franca; Gamba, Enrica; Fanin, Renato

doi:10.1182/blood-2009-07-229815

Cited by 231 publications

(218 citation statements)

References 38 publications

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“…Recently, we have updated the long-term results of the prospective Italian study, which compared dexamethasone vs. dexamethasone plus rituximab as front line therapy for adults with ITP [20]. Fifty-four patients who achieved sustained response (i.e., platelet counts 50 3 10 9 /L or more at month six from the beginning of treatment) including 13 out of initial 52 of the dexamethasone monotherapy arm, 27 out of initial 49 of the dexamethasone plus rituximab arm, and 14 out of 27 of the dexamethasone plus rituximab salvage therapy arm were subsequently followed for a median observation period of 34 months (range 4-54 months).…”

Section: Discussionmentioning

confidence: 99%

Long‐term follow‐up analysis after rituximab salvage therapy in adult patients with immune thrombocytopenia

Zaja¹,

Volpetti²,

Chiozzotto³

et al. 2012

American J Hematol

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We report the long-term outcome results of 57 consecutive adult patients with immune thrombocytopenia after being treated with rituximab. According to the different period of therapy, patients received either standard dose (SD) rituximab (i.e., 375 mg/m 2 weekly for 4 weeks) or low dose (LD) rituximab (i.e., 100 mg flat dose weekly for 4 weeks). Overall (OR) and complete response (CR) rates were 60 and 40%, respectively. Patients' median follow-up was 52 months, 82 months in the SD, and 44 months in the LD group; 15 out of 34 responsive patients (44%) relapsed, with median response duration of 24 months (range 3-120). The estimated 4-years event-free survival (EFS, considering events the non response status at month 2 or relapses in responders) was 30%. Patients who received SD vs. LD rituximab had better outcome with regard to short term response (OR 66 vs. 52%, CR 50 vs. 28%), relapse rate (38 vs. 54%), probability to achieve and maintain long-term response (41 vs. 24%) and estimated 4-years EFS (35 vs. 23%). Patients with a longer interval between diagnosis and rituximab therapy had worse EFS [HR 5 1.005; 95%IC: (1.002-1.009), P 5 0.019]. Three patients developed short-term adverse events, two-serum sickness, and one interstitial pneumonia. Four cases of malignancies and two herpes zoster reactivations were registered during long-term follow-up; one patient died for cerebral bleeding. Rituximab SD appears a safe and active agent allowing in nearly 40% of cases to achieve long-term response and splenectomy sparing effect. Am. J. Hematol. 87:886-889, 2012. V

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Section: Discussionmentioning

confidence: 99%

Long‐term follow‐up analysis after rituximab salvage therapy in adult patients with immune thrombocytopenia

Zaja¹,

Volpetti²,

Chiozzotto³

et al. 2012

American J Hematol

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“…Indeed, after rituximab administration, only 20-30% of patients maintain the response at five years, 12 with no conclusive data concerning the best timing of its use. 9,21,22 TPO-ra treatment is also effective but needs continuous administration. Moreover, no definitive safety data are available in the use of these agents over 5-6 years.…”

Section: Discussionmentioning

confidence: 99%

Splenectomy as a curative treatment for immune thrombocytopenia: a retrospective analysis of 233 patients with a minimum follow up of 10 years

et al. 2012

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“…Zaja et al [25] conducted the first randomized clinical trial in which they have compared the efficacy of treatment with Rituximab+Dexamethasone and Dexamethasone alone, in 103 newly diagnosed or chronic patients with ITP that have not received any treatment before (treatment-naïve patients).…”

Section: Discussionmentioning

confidence: 99%

“…Rituximab administration cause marked, but transit B-cell depletion, and this effect has been used for the treatment of several autoimmune diseases [15][16][17]. Rituximab is most commonly used in dose of 375mg/m 2 , in four consecutive weekly doses, and it induce overall early response rate in patients with chronic ITP of 40-70% with complete response rate of 20 to 50% [18,19]. Bhagirath et al [20] have used Rituximab in chronic relapsing thrombotic thrombocytopenic purpura (TTP) in 4 doses (375 mg/m 2 ) every four months for one year, after initial induction treatment.…”

Section: Open    Accessmentioning

confidence: 99%

Maintenance Therapy with Rituximab in Adult Patients with Immune Thrombocytopenia

et al. 2013

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Immune thrombocytopenia (ITP) is an autoimmune disease of unknown etiology, characterized by isolated thrombocytopenia and the absence of any underlying cause for thrombocytopenia. Corticosteroids are the standard first line treatment for patients with symptomatic disease, inducing platelet count recovery in 70-80% of patients; but in many cases, steroid tapering or withdrawal is followed by a decrease of platelet count and the need for additional treatment. Splenectomy is still the standard salvage therapy in cases refractory to corticosteroid therapy. In the past decade monoclonal anti-CD20 antibodies (Rituximab) are being increasingly used in patients with refractory ITP and other autoimmune diseases. Recent studies show that Rituximab is useful in the treatment of patients with chronic and refractory ITP. We report two cases with chronic ITP treated with standard dose of Rituximab in four weekly doses and than continue to receive maintenance therapy with Rituximab for 2 years.

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Dexamethasone plus rituximab yields higher sustained response rates than dexamethasone monotherapy in adults with primary immune thrombocytopenia

Cited by 231 publications

References 38 publications

Long‐term follow‐up analysis after rituximab salvage therapy in adult patients with immune thrombocytopenia

Long‐term follow‐up analysis after rituximab salvage therapy in adult patients with immune thrombocytopenia

Splenectomy as a curative treatment for immune thrombocytopenia: a retrospective analysis of 233 patients with a minimum follow up of 10 years

Maintenance Therapy with Rituximab in Adult Patients with Immune Thrombocytopenia

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