Rituximab Efficacy in the Treatment of Children with Chronic Immune Thrombocytopenic Purpura

Ansari, Shahla; Rostami, Tahereh; Yousefian, Saeed; Kiumarsi, Azadeh; Miri‐Aliabad, Ghasem; Ramim, Tayeb

doi:10.3109/08880018.2014.930766

Cited by 5 publications

(6 citation statements)

References 14 publications

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“…An increased incidence of bacterial infection is also reported in adults treated with rituximab for autoimmune diseases; the presence of diabetes and contemporary use or/and prednisone is a further risk factor. 80 , 81 Hypogammaglobulinemia has also been reported among adults and children, 76 although the overall number is unclear and appears to occur with repeated doses and in patients with underlying immune dysfunction. Studies have shown impaired humoral responses to vaccination after rituximab.…”

Section: Late Infectionsmentioning

confidence: 99%

Bacterial Infections Following Splenectomy for Malignant and Nonmalignant Hematologic Diseases

Leone¹,

Pizzigallo²

2015

Mediterr J Hematol Infect Dis

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Splenectomy, while often necessary in otherwise healthy patients after major trauma, finds its primary indication for patients with underlying malignant or nonmalignant hematologic diseases. Indications of splenectomy for hematologic diseases have been reducing in the last few years, due to improved diagnostic and therapeutic tools. In high-income countries, there is a clear decrease over calendar time in the incidence of all indication splenectomy except nonmalignant hematologic diseases. However, splenectomy, even if with different modalities including laparoscopic splenectomy and partial splenectomy, continue to be a current surgical practice both in nonmalignant hematologic diseases, such as Immune Thrombocytopenic Purpura (ITP), Autoimmune Hemolytic Anemia (AIHA), Congenital Hemolytic Anemia such as Spherocytosis, Sickle Cell Anemia and Thalassemia and Malignant Hematological Disease, such as lymphoma. Today millions of people in the world are splenectomized. Splenectomy, independently of its cause, induces an early and late increase in the incidence of venous thromboembolism and infections. Infections remain the most dangerous complication of splenectomy. After splenectomy, the levels of antibody are preserved but there is a loss of memory B cells against pneumococcus and tetanus, and the loss of marginal zone monocytes deputed to immunological defense from capsulated bacteria. Commonly, the infections strictly correlated to the absence of the spleen or a decreased or absent splenic function are due to encapsulated bacteria that are the most virulent pathogens in this set of patients. Vaccination with polysaccharide and conjugate vaccines again Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis should be performed before the splenectomy. This practice reduces but does not eliminate the occurrence of overwhelming infections due to capsulated bacteria. At present, most of infections found in splenectomized patients are due to Gram-negative (G-) bacteria. The underlying disease is the most important factor in determining the frequency and severity of infections. So, splenectomy for malignant diseases has the major risk of infections.

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Section: Late Infectionsmentioning

confidence: 99%

Bacterial Infections Following Splenectomy for Malignant and Nonmalignant Hematologic Diseases

Leone¹,

Pizzigallo²

2015

Mediterr J Hematol Infect Dis

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“…Three studies (two for eltrombopag and one for romiplostim) were shown to have a low risk of all types of bias analyzed 16,31,32 . The amount of missing information varied across the other studies, 17–25 but the highest overall bias for missing data was found in several of the RTX studies, 37,38 including missing data regarding the association between the intervention and severity of bleeding. Although it is not among the criteria for assessment of risk, it is important to note that some studies were supported by the pharmaceutical industry, with the potential for bias due to conflict of interest.…”

Section: Resultsmentioning

confidence: 99%

Thrombopoietin receptor agonists and rituximab for treatment of pediatric immune thrombocytopenia: A systematic review and meta‐analysis of prospective clinical trials

Ayad

Grace

Al‐Samkari

2021

Pediatric Blood & Cancer

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Background Children with immune thrombocytopenia (ITP) may require second‐line ITP therapies. The high remission rate in pediatric patients, need for extended‐duration use of thrombopoietin receptor agonists (TPO‐RAs), drug adherence, potential side effects, monitoring, and cost effectiveness are factors that should be considered in decision‐making about second‐line therapies. Rituximab (RTX) has been used off‐label for years to treat ITP but there are limited studies about its efficacy and safety in children. To date, no studies have directly compared TPO‐RAs with RTX for the treatment of childhood ITP. Methods This systematic review analyzed the overall platelet response, durability of treatment effect, and safety for RTX use in comparison to TPO‐RAs in pediatric ITP. MEDLINE/PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched through December 2020 and meta‐analysis was conducted using proportions of success/failure for each intervention in the selected studies. Results The proportion of participants achieving the primary endpoint of a platelet response above 50,000 was similar for TPO‐RAs (proportion = 0.71, 95% CI: 0.63–0.78) and RTX (proportion = 0.68, 95% CI: 0.53–0.82). However, considerable variation was found between the two groups with regards to the sustainability of the response and other secondary outcomes such as need for rescue and adverse events. RTX was associated with higher rates of rescue therapy. Conclusions In this analysis of prospective pediatric ITP studies, RTX and TPO‐RAs had similar rates of overall platelet response but differed in other important measures. Prospective comparative studies are needed to better characterize second‐line treatments for pediatric ITP.

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“…Rituximab, an anti‐CD20 monoclonal antibody, has also been used as treatment for both persistent/chronic ITP and AIHA in children and adults. For ITP, initial response rates vary greatly, but prolonged remission beyond 1 year is less than 50%, as evidenced by multiple studies . A recent article evaluated the long‐term response rates in a 5‐year follow‐up study for both adults and children, which showed a continued response in only 21 and 26%, respectively .…”

Section: Discussionmentioning

confidence: 99%

A novel immunomodulatory treatment involving mycophenolate mofetil and corticosteroids for pediatric autoimmune cytopenias

Panigrahi

Clark

Myers

et al. 2016

Pediatr Blood Cancer

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Our results are very promising, as MMF appears to be an effective and well-tolerated adjunct immunosuppressant that allows for rapid weaning of steroid usage, minimal adverse side effects to the patients, and long-term stabilization of counts, a goal that has not been achieved successfully with other secondary treatment modalities. Therefore, this novel combination therapy may be an excellent alternative for the treatment of persistent or chronic autoimmune cytopenias in the pediatric population.

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Rituximab Efficacy in the Treatment of Children with Chronic Immune Thrombocytopenic Purpura

Cited by 5 publications

References 14 publications

Bacterial Infections Following Splenectomy for Malignant and Nonmalignant Hematologic Diseases

Bacterial Infections Following Splenectomy for Malignant and Nonmalignant Hematologic Diseases

Thrombopoietin receptor agonists and rituximab for treatment of pediatric immune thrombocytopenia: A systematic review and meta‐analysis of prospective clinical trials

A novel immunomodulatory treatment involving mycophenolate mofetil and corticosteroids for pediatric autoimmune cytopenias

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