title: Rituximab salvage therapy in adults with immune thrombocytopenia: retrospective study on efficacy and safety profiles.
abstract: Splenectomy remains the preferred treatment for chronic immune thrombocytopenia (ITP) after corticosteroid failure, despite the risks of despite surgical complications and infection. The aim of this study was to assess the efficacy of and tolerance to rituximab through a retrospective analysis of 35 refractory/relapsing ITP patients treated from 2004 to 2013. The median age of subjects was 46 years (14-80). Rituximab was given at a weekly dose of 375 mg/m(2) for 4 weeks. Median time from diagnosis to first infusion was 17 months (1-362) and follow-up was 47 months (2-133). The overall response rates at 1 and 2 years after the first infusion were 47 and 38 %, with complete response rates of 24 and 25 %, respectively. Median duration of response was 38 months (1-123), with 37 % of patients maintaining a durable response (>1 year). Twenty-nine percent of patients had undergone splenectomy. A durable response after rituximab was more frequently observed in patients undergoing second-line therapy than those in third or later (83 versus 35 %, P = 0.01). Forty-four percent of patients experienced mild hypogammaglobulinaemia after rituximab, and no clinical infection occurred. To conclude, rituximab should be considered as an alternative treatment to splenectomy. Its efficacy and safety profile should lead us to choose this medical option therapy before surgery for ITP patients.
authors.affiliation: Department of Clinical Hematology, University Hospital Institution of Caen, Caen, France. reboursiere-e@chu-caen.fr.
authors.forename: Emilie
authors.initials: E
authors.lastname: Reboursiere
authors.affiliation: Department of Clinical Hematology, University Hospital Institution of Caen, Caen, France.
authors.forename: H
authors.initials: H
authors.lastname: Fouques
authors.affiliation: Department of Internal Medicine, University Hospital Institution of Caen, Caen, France.
authors.forename: G
authors.initials: G
authors.lastname: Maigne
authors.affiliation: Department of Clinical Hematology, University Hospital Institution of Caen, Caen, France.
authors.forename: H
authors.initials: H
authors.lastname: Johnson
authors.affiliation: Department of Clinical Hematology, University Hospital Institution of Caen, Caen, France.
authors.forename: S
authors.initials: S
authors.lastname: Chantepie
authors.affiliation: Department of Clinical Hematology, University Hospital Institution of Caen, Caen, France.
authors.forename: A C
authors.initials: AC
authors.lastname: Gac
authors.affiliation: Department of Clinical Hematology, University Hospital Institution of Caen, Caen, France.
authors.forename: O
authors.initials: O
authors.lastname: Reman
authors.affiliation: Department of Clinical Hematology, University Hospital Institution of Caen, Caen, France.
authors.forename: M
authors.initials: M
authors.lastname: Macro
authors.affiliation: Department of Clinical Hematology, University Hospital Institution of Caen, Caen, France.
authors.forename: K
authors.initials: K
authors.lastname: Benabed
authors.affiliation: Department of Hematology Biology, University Hospital Institution of Caen, Caen, France.
authors.forename: X
authors.initials: X
authors.lastname: Troussard
authors.affiliation: Department of Clinical Hematology, University Hospital Institution of Caen, Caen, France.
authors.forename: G
authors.initials: G
authors.lastname: Damaj
authors.affiliation: Department of Clinical Hematology, University Hospital Institution of Caen, Caen, France.
authors.forename: S
authors.initials: S
authors.lastname: Cheze
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004406:Dysgammaglobulinemia / Q000139:chemically induced; D006801:Humans; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy* / Q000601:surgery; D012189:Retrospective Studies; D000069283:Rituximab / Q000009:adverse effects / Q000627:therapeutic use*; D016879:Salvage Therapy / Q000379:methods* / Q000592:standards; D013156:Splenectomy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000069283:Rituximab
keywords: Hypogammaglobulinaemia; Immune thrombocytopenia; Rituximab