[Rituximab treatment for adults with steroid-resistant idiopathic thrombocytopenic purpura].
OBJECTIVE
To investigate the efficacy and safety as well as the effects of rituximab on B-lymphocytes and anti-platelet glycoprotein-specific antibodies, in patients with steroid-resistant idiopathic thrombocytopenic purpura (ITP).


METHODS
Twelve steroid-resistant ITP patients, 16 to 54 years old, received intravenous rituximab at the dose of 375 mg/m2 once--weekly for 4 weeks. Lab studies included CBC, serum concentrations of IgG, IgM and IgA. CD3+, CD4+, CD8+, CD19+, CD20+ cell numbers were assayed by flow cytometry and anti-platelet glycoprotein-specific antibodies (GP IIb/IIa, GP Ib/IX) were assayed by monoclonal antibody-specific immobilisation of platelet antigens prior to and following rituximab therapy.


RESULTS
A complete response (platelet counts > or = 100 x 10(9)/L) was observed in 4 cases, a partial response (platelet counts between 50 and 100 x 10(9)/L) in 3 cases, a minor response (platelet counts between 30 and 50 x 10(9)/L) in 2 cases, and nonresponse (platelet counts < 30 x 10(9)/L) in 3 cases. Responses were sustained 0.5 to 12 months (median 5 months). After 4 weeks of rituximab therapy, anti-platelet glycoprotein-specific antibodies (GP IIb/IIIa, GP Ib/IX) disappeared except one NR patient and CD19+/ CD20+ cells were almost depleted in all patients (295.0 +/- 86.4) x 10(6)/L vs (4.1 +/- 2.2) x 10(6)/L (P < 0.01). As expected, the T cell counts, and the serum concentrations of IgG, IgM and IgA were not changed after therapy. No severe side effects were observed.


CONCLUSIONS
Rituximab may be an effective and safe treatment for adults with steroid-resistant ITP.
Wang
Wen
W
Department of Hematology, Qilu Hospital of Shandong University, Jinan 250012, China.
Yu
Qing-Hong
QH
Zhang
Hai-Yan
HY
Chu
Xiao-Xia
XX
Chen
Feng
F
Zhang
Chun-Qing
CQ
Zhou
Yu-Hong
YH
Hou
Ming
M
D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000276:immunology; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D000069283:Rituximab; D016896:Treatment Outcome; D055815:Young Adult
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D005938:Glucocorticoids; D007155:Immunologic Factors; D000069283:Rituximab