title: Is B-cell depletion still a good strategy for treating immune thrombocytopenia?
abstract: B cells play an important role in the pathophysiology of immune thrombocytopenia (ITP). Thus, a rational approach to ITP treatment involves B-cell depletion such as with rituximab. More than 10 years after the first reports of data suggesting that anti-CD20 MoAbs could be effective treatment for ITP, we have now a clear view of its efficacy, with an overall response in about 60% of patients. The report of fatal opportunistic infections was initially a matter of concern, but to date, reassuring data have been reported and rituximab appears well tolerated with an acceptable risk of infection. In view of these data, rituximab may always be a valid option for ITP. However, relapses are frequent, and the long-term response appears modest. Therefore, strategies to ameliorate the long-term efficacy of the treatment must be developed. Several options may be tested including giving rituximab upfront or early on after ITP diagnosis, maintenance treatment with repeated infusions, and combining rituximab with other treatments able to modulate T-cell compartment to achieve a synergistic effect. New generations of B-cell targeted treatment, including new-generations anti-CD20 MoAbs, may be also tested.
authors.affiliation: Assistance publique-Hôpitaux de Paris, CHU Henri-Mondor, service de médecine interne, centre de référence des cytopénies autoimmunes de l'adulte, UPEC, 94000 Créteil, France. Electronic address: bertrand.godeau@hmn.aphp.fr.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Godeau
authors.affiliation: St George's Hospital, Haematology SpR, Blackshaw Road, Tooting, London SW17 0QT, UK.
authors.forename: Roberto
authors.initials: R
authors.lastname: Stasi
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D018951:Antigens, CD20 / Q000276:immunology; D001402:B-Lymphocytes / Q000276:immunology*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008212:Lymphocyte Depletion / Q000379:methods*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000628:therapy*; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D007155:Immunologic Factors; D000069283:Rituximab