Anti-CD20 chimeric monoclonal antibody treatment of refractory immune-mediated thrombocytopenia in a patient with chronic graft-versus-host disease.
BACKGROUND
Autoimmune thrombocytopenia in chronic graft-versus-host disease may represent an instance of B-cell dysregulation leading to clinical disease.


OBJECTIVE
To attempt to treat refractory immune-mediated thrombocytopenia in a patient with chronic graft-versus-host disease by using anti-CD20 chimeric monoclonal antibody.


METHODS
Case report.


METHODS
Academic medical center.


METHODS
A patient with chronic graft-versus-host disease after allogeneic peripheral blood stem-cell transplantation who had severe refractory immune-mediated thrombocytopenia.


METHODS
Weekly infusion of rituximab, 375 mg/m2, for 4 weeks.


METHODS
Platelet count, CD3+ cell count, and CD19+ cell count.


RESULTS
Rituximab therapy resulted in marked depletion of B cells in the peripheral blood and decreased levels of platelet-associated antibody. The increase in platelet count persisted despite tapering and discontinuation of immunosuppressive therapy for chronic graft-versus-host disease.


CONCLUSIONS
The efficacy of rituximab for the treatment of immune-mediated thrombocytopenia suggests that this drug may have activity in other autoimmune diseases or chronic graft-versus-host disease.
Blood and Marrow Stem Cell Transplant Program, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109, USA. vratanat@umich.edu
V
V
Ratanatharathorn
E
E
Carson
C
C
Reynolds
L J
LJ
Ayash
J
J
Levine
G
G
Yanik
S M
SM
Silver
J L
JL
Ferrara
J P
JP
Uberti
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018941:Antigens, CD19 / Q000097:blood; D018951:Antigens, CD20 / Q000276:immunology*; D001327:Autoimmune Diseases / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D017252:CD3 Complex / Q000097:blood; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications*; D006801:Humans; D007958:Leukocyte Count; D010976:Platelet Count; D011183:Postoperative Complications; D000069283:Rituximab; D033581:Stem Cell Transplantation; D013921:Thrombocytopenia / Q000097:blood / Q000150:complications* / Q000188:drug therapy*
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018941:Antigens, CD19; D018951:Antigens, CD20; D017252:CD3 Complex; D000069283:Rituximab