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

Abstract

The most difficult problem a physician encounters is the management of patients with idiopathic thrombocytopenic purpura (ITP), who has persistent severe thrombocytopenia after failure of initial treatment with glucocorticoids and splenectomy. Most of the patients refractory to corticosteroids and splenectomy will become refractory to other available agents, such as intravenous immunoglobulin (IVIg), danazol or chemotherapy. In this study, we investigated the effect of rituximab on 17 splenectomized refractory chronic ITP patients. Here, we showed that the anti-CD20 antibody, rituximab, induces a clinically significant response in severe chronic ITP patients, who are unresponsive to other therapeutic options. After sixth month, 10 out of 14 responders were still maintaining their durable and significant platelet responses (platelet counts >50 x 10(9)/l), without requirement to any other ITP medication. Therefore, we suggest that, rituximab is an effective treatment option in splenectomized refractory or relapsed ITP patients. Rituximab was well tolerated without severe side effects.

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

“…In particular, in the systematic review from 2007 [6] which restricted efficacy analysis to studies enrolling 5 or more patients, the overall response rate was 62.5% (95% CI 52.6-72.5). Moreover, our initial response rate is inferior to that reported by Zaja et al [15,16] in 2 papers, where the initial response rate was 65% (13/20 patients) and 73% (27/37 patients), and to that reported by other authors [17,18], with an overall response of 82 and 66%, respectively.…”

“…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.…”

Outcomes 5 years after response to rituximab therapy in children and adults with immune thrombocytopenia

“…The autoimmune disorders treated with rituximab in addition to immune thrombocytopenic purpura (ITP) 4-18 include systemic lupus erythematosus (SLE), 19,20 vasculitis, 20 rheumatoid arthritis (RA), 21 autoimmune hemolytic anemia, 11,12,22 cryoglobulinemia, 23 acquired factor VIII Abs, 24 IgM polyneuropathies, 25 and thrombotic thrombocytopenic purpura. 26 As of 2011, at least 17 studies of rituximab treatment in children and adults with ITP accruing a minimum of 5 patients each had been reported, totaling 492 patients [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][27][28][29] (Table 1). The overall response rates, complete and partial, to initial treatment with rituximab (375 mg/m 2 ϫ 4) in adults and children with ITP were both 57% (Table 1).…”

“…The overall response rates, complete and partial, to initial treatment with rituximab (375 mg/m 2 ϫ 4) in adults and children with ITP were both 57% (Table 1). Two times as many responses in adults, as defined in the original reports, [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][27][28][29] were complete responses (CR: platelet count Ͼ 150 ϫ 10 9 /L, 38%) as opposed to partial responses (PR: platelet count 50-150 ϫ 10 9 /L, 19%). In the 2 studies that assessed duration of effect according to type of initial response, patients achieving CRs had a greatly increased likelihood of maintaining their response at least 1 year from initial treatment compared with patients who achieved PRs.…”

Romiplostim: an alternative treatment option besides rituximab for the management of steroid refractory idiopathic thrombocytopenic purpura

“…To the Editor, I read with interest the recent article by Pasa et al [1] about the efficacy of rituximab in patients with refractory chronic idiopathic thrombocytopenic purpura. Steroids and immunoglobulins undoubtedly remain the center of treatment of idiopathic thrombocytopenic purpura.…”