Clinical Effect and Safety Evaluation of Different Dosage of Rituximab Combined with Cyclophosphamide in Treatment of Refractory Immune Thrombocytopenia

Overview

Journal Pak J Med Sci

Specialty General Medicine

Date 2020 Feb 18

PMID 32063934

Citations 1

Authors

Zhibin Wang

Yu Ren

Mingwei Li

Weibo Huang

Haiying Yao

Affiliations

Soon will be listed here.

Abstract

Objective: To discuss clinical effect of different dosage of rituximab combined with cyclophosphamide in treatment of refractory immune thrombocytopenia (rITP).

Method: This study was conducted at Department of Hematopathology in XX Hospital from January 2016 to January 2018. In this study. Seventy-eight patients with rITP were selected as the objects, divided into observation group (39 cases) and control group (39 cases) according to random number table. Patients in the control group were treated with conventional rituximab and cyclophosphamide, while the observation group received low-dose rituximab. The same amount of cyclophosphamide was used in the two groups. The statistics of clinical effect, recurrence rate, untoward effect and Laboratory inspection of both groups were made before and after the treatment.

Results: Compared with the control group, the total occurrence rate of side effects in the observation group decreased significantly; the level of IgM and CD20 in the observation group also decreased significantly, while. The level of IgA, IgG, CD3+ and CD4+ rose significantly (P<0.05). The differences in the level of Th1, TNF-a, IL-18 and Sc5b-9 had statistical significance before and after the treatment (P<0.05).

Conclusion: Rituximab combined with cyclophosphamide has the definite curative effect on rITP. The small dosage of rituximab combined with cyclophosphamide has higher clinical safety in the treatment.

Citing Articles

Dosage Modification of Traditional Chinese Medicine Prescriptions: An Analysis of Two Randomized Controlled Trials.

Zhou R, Zheng Y, An X, Jin D, Lian F, Tong X Front Pharmacol. 2021; 12:732698.

PMID: 34925003 PMC: 8672220. DOI: 10.3389/fphar.2021.732698.

References

Rinott N, Mashiach T, Horowitz N, Schliamser L, Sarig G, Keren-Politansky A . A 14-Year Experience in the Management of Patients with Acquired Immune Thrombotic Thrombocytopenic Purpura in Northern Israel. Acta Haematol. 2015; 134(3):170-6. DOI: 10.1159/000371867. View

Liu Q, Wu W, Wu D, Feng X, Ma Y, Li J . Clinical observation on the treatment of childhood refractory idiopathic thrombocytopenic purpura with Dihuang Zhixue Capsule. Chin J Integr Med. 2008; 14(2):132-6. DOI: 10.1007/s11655-008-0132-2. View

Neunert C, Lim W, Crowther M, Cohen A, Solberg Jr L, Crowther M . The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011; 117(16):4190-207. DOI: 10.1182/blood-2010-08-302984. View

Thota S, Kistangari G, Daw H, Spiro T . Immune thrombocytopenia in adults: an update. Cleve Clin J Med. 2012; 79(9):641-50. DOI: 10.3949/ccjm.79a.11027. View

Czuczman M, Gregory S . The future of CD20 monoclonal antibody therapy in B-cell malignancies. Leuk Lymphoma. 2010; 51(6):983-94. DOI: 10.3109/10428191003717746. View

Provan D, Stasi R, Newland A, Blanchette V, Bolton-Maggs P, Bussel J . International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2009; 115(2):168-86. DOI: 10.1182/blood-2009-06-225565. View

Grace R, Bennett C, Ritchey A, Jeng M, Thornburg C, Lambert M . Response to steroids predicts response to rituximab in pediatric chronic immune thrombocytopenia. Pediatr Blood Cancer. 2011; 58(2):221-5. PMC: 3863944. DOI: 10.1002/pbc.23130. View

Rocha A, Souza C, Rocha G, de Melo F, Clementino N, Marino M . The levels of IL-17A and of the cytokines involved in Th17 cell commitment are increased in patients with chronic immune thrombocytopenia. Haematologica. 2011; 96(10):1560-4. PMC: 3186321. DOI: 10.3324/haematol.2011.046417. View

Han H, Lu Y, Xia R . [Clinical Efficacy and Safety of Rituximab Combined with Fludarabine and Cyclophosphamide for Treatment of Chronic Lymphocytic Leukemia]. Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2016; 24(1):25-9. DOI: 10.7534/j.issn.1009-2137.2016.01.005. View

10.

Zheng R, Xie S, Niyazi S, Lu X, Sun L, Zhou Y . Meta-Analysis of the Changes of Peripheral Blood T Cell Subsets in Patients with Brucellosis. J Immunol Res. 2018; 2018:8439813. PMC: 5985067. DOI: 10.1155/2018/8439813. View

11.

Yonghao G, Jin X, Jun L, Pumei D, Ying Y, Xiuhong F . An epidemiological serosurvey of hepatitis B virus shows evidence of declining prevalence due to hepatitis B vaccination in central China. Int J Infect Dis. 2015; 40:75-80. DOI: 10.1016/j.ijid.2015.10.002. View

12.

Kashiwagi H, Tomiyama Y . Pathophysiology and management of primary immune thrombocytopenia. Int J Hematol. 2013; 98(1):24-33. DOI: 10.1007/s12185-013-1370-4. View

13.

Audia S, Rossato M, Trad M, Samson M, Santegoets K, Gautheron A . B cell depleting therapy regulates splenic and circulating T follicular helper cells in immune thrombocytopenia. J Autoimmun. 2016; 77:89-95. DOI: 10.1016/j.jaut.2016.11.002. View

14.

Gall B, Yee A, Berry B, Bircham D, Hayashi A, Dansereau J . Rituximab for management of refractory pregnancy-associated immune thrombocytopenic purpura. J Obstet Gynaecol Can. 2010; 32(12):1167-1171. DOI: 10.1016/S1701-2163(16)34741-7. View

15.

Ghanima W, Godeau B, Cines D, Bussel J . How I treat immune thrombocytopenia: the choice between splenectomy or a medical therapy as a second-line treatment. Blood. 2012; 120(5):960-9. DOI: 10.1182/blood-2011-12-309153. View

16.

Marangon M, Vianelli N, Palandri F, Mazzucconi M, Santoro C, Barcellini W . Rituximab in immune thrombocytopenia: gender, age, and response as predictors of long-term response. Eur J Haematol. 2016; 98(4):371-377. DOI: 10.1111/ejh.12839. View

17.

Godeau B . B-cell depletion in immune thrombocytopenia. Semin Hematol. 2013; 50 Suppl 1:S75-82. DOI: 10.1053/j.seminhematol.2013.03.014. View