Rituximab in the management of chronic immune thrombocytopenic purpura: an effective and safe therapeutic alternative in refractory patients

Abstract

Rituximab induces B-cell depletion; therefore, it has been used in the treatment of immune thrombocytopenic purpura (ITP). The aim of this retrospective study was to evaluate the effectiveness of rituximab in the treatment of 89 patients with chronic ITP refractory to several treatments. All the patients had platelet counts <30 x 10(9)/l. They had received a median of five (2-13) previous treatments, and 47 had undergone splenectomy. Rituximab was administered i.v. at 375 mg/m(2) in four weekly doses in 77 patients, and 12 patients received 1-6 doses. Forty-nine patients (55.1%) reached platelet counts >50 x 10(9)/l; 41 (46%) achieved a complete response (CR; platelets >100 x 10(9)/l), and eight (9%) obtained a partial response (platelets 50-100 x 10(9)/l). Overall, 31 patients (35%) maintained response, including 15 patients in whom splenectomy failed, with a median follow-up of 9 months (2-42), 12 for more than 1 year. The unique predictor of a maintained response was to reach a CR. Heavily treated patients (more than three different previous treatments, including any corticosteroids) and those with longer ITP duration (>10 years from diagnosis) had a worse response. Non-splenectomized patients had a better early response rate than those splenectomized. Rituximab was well tolerated, with two fever episodes following infusion and two reports of skin rash. Rituximab induced clinical responses in multi-treated refractory ITP patients with little toxicity and should be considered as an early therapeutic option in this setting, even as an alternative to splenectomy in selected patients.

Rituximab in Previously Treated Primary Immune Thrombocytopenia Patients: Evaluation of Short- and Long-Term Efficacy and Safety

“…This result is similar to other literature data. In fact, it is comparable with that reported in 5 other studies [9,11,12,13,14], which reported rates of 52% (13/25 patients), 54% (31/57 patients), 55.1% (49/89 patients), 44% (15/35 patients) and 57% (215/376), respectively. However, our result is inferior to some other reported data.…”

“…Moreover, Patel et al [9] did not find any relationship between initial lymphocyte subset profiles and the duration of response. Some authors have reported that a shorter disease duration is associated with a higher response rate [12,13,17,25]. Results from Zaja et al [1] and Gudbrandsdottir et al [2] in newly diagnosed pITP patients corroborate the hypothesis that better long-term effects of rituximab can be achieved when the antibody is administered earlier in the course of the disease.…”

The efficacy of rituximab in patients with splenectomized refractory chronic idiopathic thrombocythopenic purpura

“…Numerous studies about rituximab treatment for patients with refractory ITP were reported. However, most of the published studies only enrolled a limited number of patients and many were case reports [3][4][5][6][7][8].…”

Immunthrombozytopenie - Onkopedia-Leitlinien Update: Empfehlungen einer gemeinsamen Arbeitsgruppe der DGHO, ÖGHO, SGH + SSH und GPOH

“…Rituximab erreicht bei etwa 30% der chronischen ITP-Patienten langfristige - definiert als über 12 Monate anhaltende - Remissionen [48,67]. Die übliche Dosis liegt bei 375 mg/m 2 1 × pro Woche für 4 aufeinanderfolgende Wochen.…”