title: Long-term follow-up of children with refractory immune thrombocytopenia treated with rituximab.
abstract: Data on long-term outcomes of children with refractory immune thrombocytopenia (ITP) treated with rituximab are limited. We retrospectively analyzed the long-term effect of rituximab on 22 pediatric ITP patients (11 boys and 11 girls). Compete response (CR) (platelet count ≥100 × 10(9)/L) and partial response (PR) (platelet count 30-99 × 10(9)/L) were achieved in nine (41 %) and two (9 %) patients, respectively. Of the 11 responders, eight subsequently relapsed 2-26 months after initial rituximab treatment. The 5-year relapse-free rate was 14 % (3/22, 95 % confidence interval: 0-27 %) with a median follow-up period of 6.4 years. Five initial responders with subsequent relapse and one non-responder received multiple rituximab treatments of nine courses; all patients responded to the second rituximab therapy without any significant toxicity. All eight patients who relapsed after an initial response and six of 11 non-responders achieved CR or PR with subsequent treatment, including repeated courses of rituximab, splenectomy, steroids, and other immunomodulating agents. Our findings indicated that the sustained effect of rituximab on children with refractory ITP is low, but that the long-term outcome of ITP itself is not poor. Furthermore, repeated rituximab administration may be a promising therapy for those who relapse after an initial response.
authors.affiliation: Department of Pediatrics, Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan, kskmatsu@s4.dion.ne.jp.
authors.forename: Kousaku
authors.initials: K
authors.lastname: Matsubara
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Akira
authors.initials: A
authors.lastname: Hayakawa
authors.forename: Fumiko
authors.initials: F
authors.lastname: Tanaka
authors.forename: Hisaya
authors.initials: H
authors.lastname: Nakadate
authors.forename: Michio
authors.initials: M
authors.lastname: Sakai
authors.forename: Naoko
authors.initials: N
authors.lastname: Maeda
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Oka
authors.forename: Eiichi
authors.initials: E
authors.lastname: Ishii
authors.forename: Fumio
authors.initials: F
authors.lastname: Bessho
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Goto
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Hashii
authors.forename: Naoki
authors.initials: N
authors.lastname: Hatakeyama
authors.forename: Akira
authors.initials: A
authors.lastname: Shirahata
authors.forename: Masue
authors.initials: M
authors.lastname: Imaizumi
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications / Q000188:drug therapy*; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab