Rituximab for the treatment of refractory idiopathic thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP): Report of three cases

Abstract

Three patients (one with idiopathic thrombocytopenic purpura [ITP] and two with thrombotic thrombocytopenic purpura [TTP]) were treated with rituximab (anti-CD20 chimeric antibody) at a dose of 325 mg/m 2 administered weekly after they failed standard therapies. The patient with ITP who did not respond to steroids and anti-D antibody administration achieved augmentation of her platelet counts up to 180 · 10 3 /mL after four doses of rituximab. Six months later, when her counts started to decrease, she received maintenance therapy with an additional course of 4 standard doses of antibody that resulted in consolidation of her platelet counts around 100 · 10 3 /mL. One patient with TTP and concurrent idiopathic nephropathy who was previously treated with plasmapheresis, steroids, and vincristine improved only after 4 weekly administrations of the antibody. Moreover, his nephrotic-range proteinuria resolved after he received rituximab. The other patient with chronic TTP who still relapsed after splenectomy received 5 doses of rituximab with concomitant plasmapheresis. His thrombocytopenia improved slowly, and his platelet count stabilized at 300 · 10 3 /mL. All three patients showed evidence of response to anti-CD20 antibody with improvement in clinical outcome as well as augmentation of platelet counts to normal levels. We conclude that rituximab is a useful immunomodulating adjunct in the treatment of refractory ITP and TTP. Am.

Efficiency of curative and prophylactic treatment with rituximab in ADAMTS13-deficient thrombotic thrombocytopenic purpura: a study of 11 cases

“…[15][16][17][18] It has been also used as a curative treatment in small retrospective cohorts of patients with acute refractory TTP associated with a severe ADAMTS13 deficiency related to inhibitory anti-ADAMTS13 Abs. [19][20][21][22][23][24][25][26][27][28][29] Twenty-five of 26 patients achieved complete remission, and their follow-up revealed long-term remission in most cases. Rituximab has never been used as a prophylactic treatment in patients with highly recurrent TTP out of an acute episode.…”

Rituximab in the treatment of autoimmune haematological disorders

“…In rare cases where plasma exchange is not possible, rituximab treatment may play an important role in alternative treatment (Martin et al, 2007). In the majority of reports in which safety and tolerability are mentioned, rituximab was well tolerated, with few side effects noted during follow-up (Chemnitz et al, 2002;Zheng et al, 2003;Ahmad et al, 2004;Stein et al, 2004;Yomtovian et al, 2004;Fakhouri et al, 2005;Gianfaldoni et al, 2005;Kosugi et al, 2005;Koulova et al, 2005;Benetatos et al, 2006;Schleinitz et al, 2007). Rituximab infusion reactions were reported in some studies, but were generally mild in nature and did not warrant the discontinuation of rituximab (Sallah et al, 2004;Heidel et al, 2007;Scully et al, 2007).…”

Successful rituximab therapy in refractory autoimmune hepatitis and Evans syndrome

“…The effectiveness of rituximab in Evans syndrome has been established in a number of cases 6,7,13 . However, the successful treatment with rituximab for patients with a combination of Evans syndrome and concurrent autoimmune hepatitis is limited.…”

“…Although rare, serious adverse reactions including progressive multifocal leukoencephalopathy, Stevens-Johnson syndrome, serious infection from cytopenias, aplastic anemia or lymphocytopenia can occur 9 . Rituximab is considered an effective alternative therapy for refractory ITP based on the number of successful cases documented [6][7][8][9] . In this case rituximab was found to be effective against a combination of not only AIHA and ITP but also AIH.…”

“…Rituximab, with CD20 targeted, has not previously been a common mode of treatment for refractory AIH. Although there are documented cases of its effectiveness in AIHA and ITP, the data on effi cacy of rituximab specifi cally in AIH are limited [6][7][8][9][10][11][12] . We describe a case of severe AIH and Evans syndrome successfully treated with rituximab.…”