The Efficacy of Rituximab in Patients with Splenectomized Refractory Chronic Idiopathic Thrombocythopenic Purpura

Overview

Journal J Thromb Thrombolysis

Specialty Cardiology & Vascular Diseases

Date 2008 Mar 4

PMID 18311541

Citations 6

Authors

Semir Pasa

Abdullah Altintas

Timucin Cil

Ramazan Danis

Orhan Ayyildiz

Affiliations

Soon will be listed here.

Abstract

The most difficult problem a physician encounters is the management of patients with idiopathic thrombocytopenic purpura (ITP), who has persistent severe thrombocytopenia after failure of initial treatment with glucocorticoids and splenectomy. Most of the patients refractory to corticosteroids and splenectomy will become refractory to other available agents, such as intravenous immunoglobulin (IVIg), danazol or chemotherapy. In this study, we investigated the effect of rituximab on 17 splenectomized refractory chronic ITP patients. Here, we showed that the anti-CD20 antibody, rituximab, induces a clinically significant response in severe chronic ITP patients, who are unresponsive to other therapeutic options. After sixth month, 10 out of 14 responders were still maintaining their durable and significant platelet responses (platelet counts >50 x 10(9)/l), without requirement to any other ITP medication. Therefore, we suggest that, rituximab is an effective treatment option in splenectomized refractory or relapsed ITP patients. Rituximab was well tolerated without severe side effects.

Citing Articles

Comparison of Response to Rituximab Therapy in Adults with Refractory Symptomatic Immune Thrombocytopenia According to the Presence of Accessory Spleen.

Hindilerden F, Yonal-Hindilerden I, Yenerel M, Nalcaci M, Diz-Kucukkaya R Hematol Rep. 2022; 14(3):222-227.

PMID: 35893154 PMC: 9326767. DOI: 10.3390/hematolrep14030030.

Updated international consensus report on the investigation and management of primary immune thrombocytopenia.

Provan D, Arnold D, Bussel J, Chong B, Cooper N, Gernsheimer T Blood Adv. 2019; 3(22):3780-3817.

PMID: 31770441 PMC: 6880896. DOI: 10.1182/bloodadvances.2019000812.

Rituximab Therapy in Adults with Refractory Symptomatic Immune Thrombocytopenia: Long-Term Follow-Up of 15 Cases.

Hindilerden F, Yonal-Hindilerden I, Yenerel M, Nalcaci M, Diz-Kucukkaya R Turk J Haematol. 2016; 34(1):72-80.

PMID: 27102929 PMC: 5451692. DOI: 10.4274/tjh.2016.0086.

Cost-effectiveness of adding rituximab to splenectomy and romiplostim for treating steroid-resistant idiopathic thrombocytopenic purpura in adults.

Kikuchi K, Miyakawa Y, Ikeda S, Sato Y, Takebayashi T BMC Health Serv Res. 2015; 15:2.

PMID: 25609557 PMC: 4307915. DOI: 10.1186/s12913-015-0681-y.

Outcomes 5 years after response to rituximab therapy in children and adults with immune thrombocytopenia.

Patel V, Mahevas M, Lee S, Stasi R, Cunningham-Rundles S, Godeau B Blood. 2012; 119(25):5989-95.

PMID: 22566601 PMC: 3383014. DOI: 10.1182/blood-2011-11-393975.

References

Cooper N, Stasi R, Cunningham-Rundles S, Feuerstein M, Leonard J, Amadori S . The efficacy and safety of B-cell depletion with anti-CD20 monoclonal antibody in adults with chronic immune thrombocytopenic purpura. Br J Haematol. 2004; 125(2):232-9. DOI: 10.1111/j.1365-2141.2004.04889.x. View

Kumar S, Diehn F, Gertz M, Tefferi A . Splenectomy for immune thrombocytopenic purpura: long-term results and treatment of postsplenectomy relapses. Ann Hematol. 2002; 81(6):312-9. DOI: 10.1007/s00277-002-0461-8. View

Stasi R, Stipa E, Forte V, Meo P, Amadori S . Variable patterns of response to rituximab treatment in adults with chronic idiopathic thrombocytopenic purpura. Blood. 2002; 99(10):3872-3. DOI: 10.1182/blood-2002-02-0392. View

Stasi R, Provan D . Management of immune thrombocytopenic purpura in adults. Mayo Clin Proc. 2004; 79(4):504-22. DOI: 10.4065/79.4.504. View

Penalver F, Jimenez-Yuste V, Almagro M, Alvarez-Larran A, Rodriguez L, Casado M . Rituximab in the management of chronic immune thrombocytopenic purpura: an effective and safe therapeutic alternative in refractory patients. Ann Hematol. 2006; 85(6):400-6. DOI: 10.1007/s00277-005-0073-1. View

Portielje J, Westendorp R, Kluin-Nelemans H, Brand A . Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood. 2001; 97(9):2549-54. DOI: 10.1182/blood.v97.9.2549. View

Moschovi M, Trimis G, Pergantou H, Platokouki H, Vrachnou E, Tzortzatou-Stathopoulou F . Clinical remission following monoclonal anti-CD20 therapy in two children with chronic refractory idiopathic thrombocytopenic purpura. J Paediatr Child Health. 2005; 41(7):384-6. DOI: 10.1111/j.1440-1754.2005.00641.x. View

Saleh M, Gutheil J, Moore M, Bunch P, Butler J, Kunkel L . A pilot study of the anti-CD20 monoclonal antibody rituximab in patients with refractory immune thrombocytopenia. Semin Oncol. 2001; 27(6 Suppl 12):99-103. View

Giagounidis A, Anhuf J, Schneider P, Germing U, Sohngen D, Quabeck K . Treatment of relapsed idiopathic thrombocytopenic purpura with the anti-CD20 monoclonal antibody rituximab: a pilot study. Eur J Haematol. 2002; 69(2):95-100. DOI: 10.1034/j.1600-0609.2002.02686.x. View

10.

Vianelli N, Galli M, De Vivo A, Intermesoli T, Giannini B, Mazzucconi M . Efficacy and safety of splenectomy in immune thrombocytopenic purpura: long-term results of 402 cases. Haematologica. 2005; 90(1):72-7. View

11.

Stasi R, Pagano A, Stipa E, Amadori S . Rituximab chimeric anti-CD20 monoclonal antibody treatment for adults with chronic idiopathic thrombocytopenic purpura. Blood. 2001; 98(4):952-7. DOI: 10.1182/blood.v98.4.952. View

12.

Andersson P, Wadenvik H . Chronic idiopathic thrombocytopenic purpura (ITP): molecular mechanisms and implications for therapy. Expert Rev Mol Med. 2004; 6(24):1-17. DOI: 10.1017/S1462399404008415. View

13.

Yang R, Han Z . Pathogenesis and management of chronic idiopathic thrombocytopenic purpura: an update. Int J Hematol. 2000; 71(1):18-24. View

14.

Bennett C, Rogers Z, Kinnamon D, Bussel J, Mahoney D, Abshire T . Prospective phase 1/2 study of rituximab in childhood and adolescent chronic immune thrombocytopenic purpura. Blood. 2005; 107(7):2639-42. PMC: 1895391. DOI: 10.1182/blood-2005-08-3518. View

15.

Schwartz J, Leber M, Gillis S, Giunta A, Eldor A, Bussel J . Long term follow-up after splenectomy performed for immune thrombocytopenic purpura (ITP). Am J Hematol. 2003; 72(2):94-8. DOI: 10.1002/ajh.10253. View

16.

Zhou Z, Yang R . Rituximab treatment for chronic refractory idiopathic thrombocytopenic purpura. Crit Rev Oncol Hematol. 2007; 65(1):21-31. DOI: 10.1016/j.critrevonc.2007.06.007. View

17.

Kojouri K, Vesely S, Terrell D, George J . Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood. 2004; 104(9):2623-34. DOI: 10.1182/blood-2004-03-1168. View

18.

Braendstrup P, Bjerrum O, Nielsen O, Jensen B, Clausen N, Hansen P . Rituximab chimeric anti-CD20 monoclonal antibody treatment for adult refractory idiopathic thrombocytopenic purpura. Am J Hematol. 2005; 78(4):275-80. DOI: 10.1002/ajh.20276. View