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Clinical Trial
. 2007 Dec;86(12):871-7.
doi: 10.1007/s00277-007-0317-3. Epub 2007 Sep 14.

Rituximab therapy for chronic and refractory immune thrombocytopenic purpura: a long-term follow-up analysis

Jaime Garcia-Chavez  1 , Abraham Majluf-Cruz, Laura Montiel-Cervantes, Miriam García-Ruiz Esparza, Jorge Vela-Ojeda; Mexican Hematology Study Group
Affiliations
Clinical Trial

Rituximab therapy for chronic and refractory immune thrombocytopenic purpura: a long-term follow-up analysis

Jaime Garcia-Chavez et al. Ann Hematol. 2007 Dec.

Abstract

The aim of this study was to evaluate the long-term response to rituximab in patients with chronic and refractory immune thrombocytopenic purpura (ITP). Adults with ITP fail to respond to conventional therapies in almost 30% of cases, developing a refractory disease. Rituximab has been successfully used in these patients. We used rituximab at 375 mg/m2, IV, weekly for a total of four doses in 18 adult patients. Complete remission (CR) was considered if the platelet count was >100 x 10(9)/l, partial remission (PR) if platelets were >50 x 10(9)/l, minimal response (MR) if the platelet count was >30 x 10(9)/l and <50 x 10(9)/l, and no response if platelet count remained unchanged. Response was classified as sustained (SR) when it was stable for a minimum of 6 months. Median age was 43.5 years (range, 17 to 70). Median platelet count at baseline was 12.5 x 10(9)/l (range, 3.0 to 26.3). CR was achieved in five patients (28%), PR in five (28%), MR in four (22%), and two patients were classified as therapeutic failures (11%). Two additional patients were lost to follow-up. The median time between rituximab therapy and response was 14 weeks (range, 4 to 32). SR was achieved in 12 patients (67%). There were no severe adverse events during rituximab therapy. During follow-up (median, 26 months; range, 12 to 59), no other immunosuppressive drugs were used. In conclusion, rituximab therapy is effective and safe in adult patients with chronic and refractory ITP. Overall response rate achieved is high, long term, and with no risk of adverse events.

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Figures

Fig. 1
Fig. 1
Platelet count achieved after first dose of rituximab (time 0 first dose of rituximab). Diamonds, CR; ovals, PR; triangles, MR
Fig. 2
Fig. 2
Time required to obtain platelet counts >50 × 109/l (a) or >100 × 109/l (b) after first dose of rituximab in adult patients with chronic and refractory ITP
Fig. 3
Fig. 3
Median duration of response for patients who achieved complete remission (CR; 54 months, 95%CI = 15–93 months), partial remission (PR; 18 months, 95%CI = 8–28 months), or minor response (MR; 12 months, 95%CI = 7–17 months)
Fig. 4
Fig. 4
Mean (squares), maximum (diamonds), and minimum (triangles) neutrophil counts through the follow-up of patients receiving rituximab for chronic and refractory ITP
See this image and copyright information in PMC

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