title: Successful treatment of a patient with hairy cell leukemia and pentostatin-induced autoimmune thrombocytopenia with rituximab.
abstract: The treatment of choice for hairy cell leukemia (HCL) are the purine analogs pentostatin and cladribine. They induced complete remissions in up to 85% of patients. Purine analogs are known to induce autoimmune phenomena, but there are no reports of autoimmune thrombocytopenia after treatment with pentostatin. This case report describes the very rare association of pentostatin-treated hairy cell leukemia and autoimmune thrombocytopenia. Encouraged by first reports of promising activity of the anti-CD20 monoclonal antibody rituximab in patients with autoimmune disorders, we decided to treat our patient with rituximab in the conventional dose of 375 mg/m(2) i.v. weekly for 4 cycles. One week after the first administration, the peripheral blood count has recovered with a normal platelet count. 22 weeks after completion of therapy, the patient is still in complete hematologic remission without further medication. In conclusion, rituximab seems to be a new, promising drug in the treatment of refractory autoimmune thrombocytopenia even in patients with underlying lymphoproliferative disorders.
authors.affiliation: Department of Internal Medicine V, University of Heidelberg, Hospitalstrasse 3, D-69115 Heidelberg, Germany. Manfred_Hensel@med.uni-heidelberg.de
authors.forename: Manfred
authors.initials: M
authors.lastname: Hensel
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Ho
mesh_terms: D000903:Antibiotics, Antineoplastic / Q000009:adverse effects; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006801:Humans; D007943:Leukemia, Hairy Cell / Q000178:diet therapy*; D008297:Male; D008875:Middle Aged; D015649:Pentostatin / Q000009:adverse effects*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000139:chemically induced* / Q000188:drug therapy*; D012008:Recurrence; D012074:Remission Induction; D000069283:Rituximab; D013156:Splenectomy
chemical_list: D000903:Antibiotics, Antineoplastic; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D015649:Pentostatin; D000069283:Rituximab