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

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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 × 109/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.

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References

  1. Yang R, Han ZC (2000) Pathogenesis and management of chronic idiopathic thrombocytopenic purpura: an update. Int J Hematol 71:18–24

    PubMed  CAS  Google Scholar 

  2. Andersson PO, Wadenvik H (2004) Chronic idiopathic thrombocytopenic purpura (ITP): molecular mechanisms and implications for therapy. Expert Rev Mol Med 6:1–17

    Article  PubMed  Google Scholar 

  3. Zhou Z, Yang R. (2007) Rituximab treatment for chronic refractory idiopathic thrombocytopenic purpura. Crit Rev Oncol Hematol, doi:10.1016/j.critrevonc.2007.06.007

  4. Braendstrup P, Bjerrum OW, Nielsen OJ et al (2005) Rituximab chimeric anti-CD20 monoclonal antibody treatment for adult refractory idiopathic thrombocytopenic purpura. Am J Hematol 78:275–280

    Article  PubMed  CAS  Google Scholar 

  5. Giagounidis AA, Anhuf J, Schneider P et al (2002) Treatment of relapsed idiopathic thrombocytopenic purpura with the anti-CD20 monoclonal antibody rituximab: a pilot study. Eur J Haematol 69:95–100

    Article  PubMed  CAS  Google Scholar 

  6. Cooper N, Stasi R, Cunningham-Rundles S et al (2004) The efficacy and safety of B-cell depletion with anti-CD20 monoclonal antibody in adults with chronic immune thrombocytopenic purpura. Br J Haematol 125:232–239

    Article  PubMed  CAS  Google Scholar 

  7. Peñalver FJ, Jiménez-Yuste V, Almagro M et al (2006) Rituximab in the management of chronic immune thrombocytopenic purpura: an effective and safe therapeutic alternative in refractory patients. Ann Hematol 85:400–406

    Article  PubMed  Google Scholar 

  8. Bennett CM, Rogers ZR, Kinnamon DD et al (2006) Prospective phase 1/2 study of rituximab in childhood and adolescent chronic immune thrombocytopenic purpura. Blood 107:2639–2642

    Article  PubMed  CAS  Google Scholar 

  9. Stasi R, Pagano A, Stipa E et al (2001) Rituximab chimeric anti-CD20 monoclonal antibody treatment for chronic idiopathic thrombocytopenic purpura. Blood 98:952–957

    Article  PubMed  CAS  Google Scholar 

  10. Stasi R, Stipa E, Forte V et al (2002) Variable patterns of response to rituximab treatment in adults with chronic idiopathic thrombocytopenic purpura. Blood 99:3872–3873

    Article  PubMed  CAS  Google Scholar 

  11. Moschovi M, Trimis G, Pergantou H et al (2005) Clinical remission following monoclonal anti-CD20 therapy in two children with chronic refractory idiopathic thrombocytopenic purpura. J Paediatr Child Health 41:384–386

    Article  PubMed  Google Scholar 

  12. Kojouri K, Vesely SK, Terrell DR et al (2004) Splenectomy for adults patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count response, prediction of response, and surgical complications. Blood 104:2623–2634

    Article  PubMed  CAS  Google Scholar 

  13. Kumar S, Diehn FE, Gertz MA et al (2002) Splenectomy for immune thrombocytopenic purpura: long-term results and treatment of postsplenectomy relapses. Ann Hematol 81:312–319

    Article  PubMed  CAS  Google Scholar 

  14. Stasi R, Provan D (2004) Management of immune thrombocytopenic purpura in adults. Mayo Clin Proc 79:504–522

    Article  PubMed  Google Scholar 

  15. Vianelli N, Galli M, de Vivo A et al (2005) Efficacy and safety of splenectomy in immune thrombocytopenic purpura: long-term results of 402 cases. Haematologica 90:4

    Google Scholar 

  16. Schwartz J, Leber MD, Gillis S et al (2003) Long-term follow-up after splenectomy performed for immune thrombocytopenic purpura (ITP). Am J Hematol 72:94–98

    Article  PubMed  Google Scholar 

  17. Saleh MN, Gutheil J, Moore M et al (2000) A pilot study of the anti-CD20 monoclonal antibody rituximab in patients with refractory immune thrombocytopenia. Semin Oncol 27:99–103

    PubMed  CAS  Google Scholar 

  18. Portielje JE, Westendorp RG, Kluin-Nelemans HC et al (2001) Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood 97:2549–2554

    Article  PubMed  CAS  Google Scholar 

  19. Bennett CM, Rogers ZR, Kinnamon DD et al (2006) Prospective phase 1/2 study of rituximab in childhood and adolescent chronic immune thrombocytopenic purpura. Blood 107:2639–2642

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Semir Pasa.

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Pasa, S., Altintas, A., Cil, T. et al. The efficacy of rituximab in patients with splenectomized refractory chronic idiopathic thrombocythopenic purpura. J Thromb Thrombolysis 27, 329–333 (2009). https://doi.org/10.1007/s11239-008-0208-z

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  • DOI: https://doi.org/10.1007/s11239-008-0208-z

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