Chronic immune thrombocytopenic purpura in children: assessment of rituximab treatment.
OBJECTIVE
This study examined the efficacy and safety of rituximab in children with chronic immune thrombocytopenic purpura.


METHODS
Twenty-four patients, 2 to 19 years of age, with platelet counts <30,000/mcL (microliter 2), received 375 mg/m 2 rituximab in 4 weekly doses. Platelet response was characterized as complete (CR) if a count >150,000/mcL was achieved; partial (PR) if 50,000 to 150,000/mcL; minimal (MR) if the count increased by >20,000/mcL to a peak count >30,000/mcL but <50,000/mcL; or no response (NR).


RESULTS
Fifteen of 24 patients (63%) achieved a CR lasting 4 to 30 months, 9 of which are ongoing. Two had PRs lasting 4 and 6 months; 2 had MRs lasting 5 and 8 months, and 5 did not respond. Pruritus, urticaria, and throat tightness (but no respiratory distress) occurred with the first infusion in a small number of children. Three patients had serum sickness after the first, second, and third infusions, respectively. No increased frequency or severity of infections was seen, although immunoglobulin levels decreased to below the normal range in 6 of 14 cases.


CONCLUSIONS
Rituximab may be a useful treatment for chronic immune thrombocytopenic purpura in children with a >50% CR rate lasting an average of 13 months, with 9 of 15 CRs ongoing (8 lasted 6 months or longer). There was no substantial toxicity other than transient serum sickness.
Wang
Julie
J
Department of Pediatrics, Division of Allergy and Immunology, Mount Sinai Medical Center, New York, New York 10029, USA. jwang96@post.harvard.edu <jwang96@post.harvard.edu>
Wiley
Joseph M
JM
Luddy
Ruth
R
Greenberg
Jay
J
Feuerstein
Michael A
MA
Bussel
James B
JB
D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001792:Blood Platelets / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006261:Headache / Q000139:chemically induced; D006801:Humans; D007223:Infant; D007970:Leukopenia / Q000139:chemically induced; D008297:Male; D009503:Neutropenia / Q000139:chemically induced; D010865:Pilot Projects; D010976:Platelet Count; D011696:Purpura, Thrombocytopenic / Q000188:drug therapy*; D000069283:Rituximab; D016896:Treatment Outcome; D014581:Urticaria / Q000139:chemically induced
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab