title: Rituximab in immune thrombocytopenia: transient responses, low rate of sustained remissions and poor response to further therapy in refractory patients.
abstract: Management of patients with immune thrombocytopenia (ITP) refractory to standard treatment is difficult. Recent studies show that rituximab, a chimeric anti-CD20 monoclonal antibody, is useful in the treatment of ITP. We retrospectively studied 24 patients who received 29 rituximab treatments for relapsed or refractory ITP. Patients had received a median of 3 treatment regimens before (range 1-8) and 11 patients had prior splenectomy. Responses were achieved in 19 of 29 (66%) treatments. The median time to response was 3 weeks (range 1-20) from the start of therapy and median duration of response was 13 weeks (range 1 week-55 months). Responses were mostly short lived and after a median follow-up of 22 months (range 2-70), 10 (34%) responses were sustained after 6 months, 7 (24%) responses sustained after 1 year and only 5 patients continued to have a response at last visit after 8, 10, 24, 30 and 54 months of follow-up. Previous splenectomy was associated with a poor response (p=0.034). Patients who failed rituximab and had prior multiple treatments including splenectomy, had a poor outcome of further therapies. We conclude that rituximab is well tolerated and is useful in some patients with relapsed or refractory ITP; however, only about one-fifth of patients achieved sustained remissions. Patients refractory to rituximab had a poor response to further treatment.
authors.affiliation: The Division of Haematology/Oncology, Department of Medicine (38), College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. aameraleem@hotmail.com
authors.forename: Aamer
authors.initials: A
authors.lastname: Aleem
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: Alaskar
authors.forename: Farja
authors.initials: F
authors.lastname: Algahtani
authors.forename: Mushtaq
authors.initials: M
authors.lastname: Rather
authors.forename: Muhamad Hitham
authors.initials: MH
authors.lastname: Almahayni
authors.forename: Abdulkarim
authors.initials: A
authors.lastname: Al-Momen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy*; D012074:Remission Induction; D012189:Retrospective Studies; D000069283:Rituximab; D016879:Salvage Therapy; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab