Treatment of chronic immune thrombocytopenic purpura with rituximab.
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Date
2009-11
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Abstract
Objective. To evaluate the rituximab treatment in children with chronic immune thrombocytopenic purpura
Methods. This study included ten children with chronic immune thrombocytopenic purpura, which were nonresponsive to
Steroid (S), IVIG and anti-D treatments. Rituximab was given with a dosage of 375 mg/m2 weekly for 4-6 weeks. Initial
platelet count was less than 30x109/L and responses were assessed in follow-up. The patients’ groups were categorized
as complete remission (CR);a platelet count ≥150x109/L,partial remission (PR);a platelet count ranging from 50x109/L to
150x109/L, minimal remission (MR); a platelet count ranging from 30x109/L to 50x109/L and no response (NR); a platelet
count less than 30x109/L.
Results. Of our patients, four female and six male, their ages ranged from 39 mth to 13 yr and the mean age was
83.4±44.58 mo. None of the patients was splenectomized. The follow-up period after rituximab treatment ranged between
12 to 42 mo and the mean follow-up period was 25.10±13.03 months. While on this treatment, we had a CR in two patients,
a PR in one, a MR in three, but no response in four. The patients in CR/PR are still being followed as in remission and they
have 40 mo of mean follow-up period. The three patients in MR had a decrease in values of platelets earliest in one mo and
the latest in four mo. Adverse effects of rituximab, such as itching and scraps that were not clinically significant were
observed in three patients during rituximab infusion. There were no increase in infections after rituximab in any patient.
Conclusion. CR was found in 20% of our patients, PR in 10% and MR in 30% with rituximab. On this treatment, while some
series had good outcomes with this treatment (72%-100%, remission ratios), but many series, such as ours, had a poor
response rate contrast to many reported case series in the literature. This condition may be associated with the age of our
most patients who were young at the time of commenced rituximab. However, we believe that more studies are required to
elucidate the reasons for different results in different case series reported in literature.
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Keywords
Rituximab, Chronic ITP, Children
Citation
Dogan Murat, Oner Ahmet F, Acikgoz Mehmet, Uner Abdurrahman. Treatment of chronic immune thrombocytopenic purpura with rituximab. Indian Journal of Pediatrics. 2009 Nov; 76(11): 1141-1144.