title: [Efficacy of high-dose dexamethasone plus low-dose rituximab as a second-line treatment in 65 patients with primary immune thrombocytopenia].
abstract: OBJECTIVE
  To observe the efficacy of high-dose dexamethasone in combination with low-dose rituximab as a second-line treatment for patients with immune thrombocytopenia (ITP).
  
  
  METHODS
  65 patients with ITP, previously by conventional dose of glucocorticoids, received high-dose dexamethasone in combination with low-dose rituximab (dexamethasone 40 mg/d for 4 days, rituximab 100 mg, d 7, 14, 21, 28 intravenous infusion). Treatment response, regulatory T cells (Treg), cytokines levels and treatment-related adverse effects were observed.
  
  
  RESULTS
  Total response rate 1 month after treatment was achieved in 81.5% (53/65) of patients, and complete response at 3,6 and 12 months was 72.3% (47/65), 66.2%(43/65), 63.1%(41/65). The higher efficiency and complete response rate was achieved in preexisting glucocorticoid-dependent patients. For patients with complete response, Treg cells continued to show a high level state [(3.01 ± 0.95)% vs (1.69 ± 0.35)%, P=0.032], cytokines of BAFF [(648.03 ± 79.63) ng/L vs (972.35 ± 93.64) ng/L, P=0.001], IL-2 [(2.84 ± 0.32) ng/L vs (4.18 ± 0.46) ng/L, P=0.012], sCD40L[(4.55 ± 0.66) ng/L vs (7.73 ± 1.04) ng/L, P=0.006] significantly lower than that before treatment. The level of IL-10 was increased, but without significance compared with that before treatment (P=0.136). All patients completed the protocol with no serious adverse reactions.
  
  
  CONCLUSIONS
  The data show high-dose dexamethasone in combination with low-dose rituximab still has a satisfactory outcomes for patients previously with conventional dose of glucocorticoid.
authors: Department of Hematology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China.
authors: Zhiling
authors: Z
authors: Yan
authors: Department of Hematology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China.
authors: Zhenyu
authors: Z
authors: Li
authors: Department of Hematology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China.
authors: Huanxin
authors: H
authors: Zhang
authors: Department of Hematology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China.
authors: Chong
authors: C
authors: Chen
authors: Department of Hematology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China.
authors: Depeng
authors: D
authors: Li
authors: Department of Hematology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China.
authors: Weiwei
authors: W
authors: Xing
authors: Department of Hematology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China.
authors: Hujun
authors: H
authors: Li
authors: Department of Hematology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China.
authors: Wei
authors: W
authors: Chen
authors: Department of Hematology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China.
authors: Hai
authors: H
authors: Cheng
authors: Department of Hematology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China.
authors: Jiang
authors: J
authors: Cao
authors: Department of Hematology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China.
authors: Kailin
authors: K
authors: Xu
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived; D016207:Cytokines; D003907:Dexamethasone; D004338:Drug Combinations; D005938:Glucocorticoids; D006801:Humans; D016553:Purpura, Thrombocytopenic, Idiopathic; D000069283:Rituximab; D050378:T-Lymphocytes, Regulatory
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D016207:Cytokines; D004338:Drug Combinations; D005938:Glucocorticoids; D000069283:Rituximab; D003907:Dexamethasone