Rituximab therapy in adult patients with relapsed or refractory immune thrombocytopenic purpura: long‐term follow‐up results

Medeot, Marta; Zaja, Francesco; Vianelli, Nicola; Battista, Marta Lisa; Baccarani, Michele; Patriarca, Francesca; Soldano, Franca; Isola, Miriam; Luca, Stefano De; Fanin, Renato

doi:10.1111/j.1600-0609.2008.01100.x

Cited by 68 publications

(81 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The results of our analysis confirm the short to mid-term effect of rituximab salvage therapy in adult patients with ITP reported earlier by our group and other authors [4][5][6][7][8][9][10][11][12]. Our data might suggest SD is the preferable therapeutic regimen due to the shorter timing of response, the higher response rate, the lower incidence of relapse, and the similar safety profile.…”

Section: Discussionsupporting

confidence: 90%

“…Fifty-seven consecutive Caucasian adult patients were included into this survey; the results observed in the first 27 patients have already been reported [12] but had been in this article updated with longer follow-up. Table I summarizes patients' main characteristics.…”

Section: Resultsmentioning

confidence: 99%

“…In a previous report, we already evaluated the long-term effect of rituximab in 27 patients with ITP showing that 9 out of initial 27 patients (33%) maintained such response, with an estimated 61% 5-years relapse-free survival [12]. Recently, Patel et al [13], analyzing data of 72 adults and 66 children with ITP who had at least an initial response to rituximab, calculated an estimated 5-years response rate of 21 and 30%, respectively.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Zaja¹,

Volpetti²,

Chiozzotto³

et al. 2012

American J Hematol

Self Cite

View full text Add to dashboard Cite

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

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Zaja¹,

Volpetti²,

Chiozzotto³

et al. 2012

American J Hematol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Ceccarelli's safety study on SLE found adverse event rates comparable to the placebo, with the only differences being leukopenia (12.3% vs. 4.2%), neutropenia (5.5% vs. 1.4%) and hypotension (11% vs. 4.2%). 15 Medeot et al, 16 on the other hand, ascertained a rituximab safety profile in patients with refractory ITP. They found that rituximab administration was associated with two episodes of short-term toxicity, namely a mild infusion reaction and a case of serum sickness syndrome, which improved rapidly with steroids; no infectious or other significant longterm complications were documented.…”

Section: Discussionmentioning

confidence: 99%

The Off-Label Use of Rituximab for the Management of Inflammatory Disorders: American University of Beirut Medical Center Experience

Harb

2014

Arch Rheumatol

View full text Add to dashboard Cite

Biologists have been extensively investigating a promising therapy in the management of multiple inflammatory and autoimmune diseases. Rituximab is a chimeric (murine/human) monoclonal antibody, which targets a cluster of 20 different antigens (CD20) found on the surface of B-lymphocytes.Rituximab is approved by the Food and Drug Administration (FDA) for the treatment of rheumatoid arthritis, non-Hodgkin's lymphoma 1 and recently of anti-neutrophilic cytoplasmic antibody (ANCA)-associated vasculitis (AAV).2 In addition to these indications, rituximab is being used as an off-label treatment in a number of inflammatory and systemic autoimmune diseases. Off-label use dictates the prescription of a registered medicine for a use that is not included in the product information. It is considered appropriate when there is high-quality evidence, or where the use is within the context of a formal research proposal, or in exceptional cases, justified by clinical situations.3 Rituximab has been tried as an off-label treatment for many conditions including systemic lupus erythematosus (SLE), Sjögren's syndrome, idiopathic thrombocytopenic purpura (ITP), systemic vasculitides, bullous dermatologicObjectives: This study aims to evaluate the efficacy of off-label use of rituximab with possible side effects. Patients and methods: Records of the 44 American University of Beirut Medical Center pharmacies were searched for patients who used rituximab over the past 4.5 years, and data on rituximab dosage, protocol and side effects were documented. The majority of patients had systemic lupus erythematosus. Autoimmune thrombocytopenic purpura, antiphospholipid syndrome, Sjögren's syndrome, Wegener's granulomatosis, autoimmune hemolytic anemia, dermatomyositis, and pemphigus vulgaris were also reported. Outcome measures were improvement in signs and symptoms during a follow-up period of two years. Results: Twenty-nine out of the 44 patients had complete response without relapse. Of those, 12 patients were in remission after the first cycle. Of the systemic lupus erythematosus cases, 12 had complete response without relapse; of which, five patients had remission after the first cycle. No significant toxicities were noted. Conclusion:The off-label use of rituximab in various inflammatory diseases showed improvement in symptoms with no significant side effects in patients who have failed previous treatment with multiple conventional regimens.

show abstract

“…The use of CD-20 antigen (monoclonal antibodies against B-cell) was analyzed in systematic metaanalysis which included more than 300 ITP patients [20][21][22][23]. The response rate was 25-75%, CR -33% of cases, lasting up to three years [22][23][24][25] and the only common sideeffect was infusion reactions [26]. Patel V. and colleagues documented ITP patients treated with monoclonal antibodies 5-year relapse-free and treatment-free survival of 72% and 61% respectively [27].…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for positive immune thrombocytopenic purpura outcome after laparoscopic splenectomy

Kiudelis¹,

Mickevičius²,

Dambrauskienė³

et al. 2010

Open Medicine

View full text Add to dashboard Cite

AbstractLaparoscopic splenectomy is considered as a second step treatment for ITP patients. The purpose of this study was to determine efficiency of laparoscopic splenectomy for ITP patients and to identify the independent prognostic factors that may predict the positive outcome. Two hundred and thirty nine patient medical records were analyzed retrospectively. The special questionnaire, which included present platelet count, the steroid usage and its dosage, was sent to all patients. The complete response (CR) was defined, when the platelet count was above 130 × 109 /L. The 239 adult patients with a median age of 51.3 (16–93 years) were included in this cohort. The median follow up period was 75 months. 49 patients, who relapsed after steroid treatment, underwent laparoscopic splenectomy. The short term postoperative CR was 71.4% after laparoscopic splenectomy compared to 38.1% in non-splenectomized patients (p < 0.000). The long term CR was 79.5 % in patients after splenectomy compared to 47.4% in non-splenectomized patients (p < 0.018). After univaried analysis three clinical variables were found to be significantly related to splenectomy outcome: disease duration (p<0.007), preoperative platelet count (p<0.049) and platelet count on the third postoperative day (p<0.000). Multiple logistic regression analysis demonstrated, that only platelet count on the 3rd postoperative day > 129 × 109 /L; RR=53.3 95% (CI, 1.888–1517.98) was significant predictor for long-term positive ITP outcome after laparoscopic splenectomy. Splenectomy is effective treatment for ITP. Platelet count > 129 × 109/L on the third postoperative day is the significant predictor of positive long-term outcome after laparoscopic splenectomy.

show abstract

Rituximab therapy in adult patients with relapsed or refractory immune thrombocytopenic purpura: long‐term follow‐up results

Cited by 68 publications

References 12 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

The Off-Label Use of Rituximab for the Management of Inflammatory Disorders: American University of Beirut Medical Center Experience

Prognostic factors for positive immune thrombocytopenic purpura outcome after laparoscopic splenectomy

Contact Info

Product

Resources

About