Rituximab treatment for chronic refractory idiopathic thrombocytopenic purpura

Zhou, Zeping; Yang, Renchi

doi:10.1016/j.critrevonc.2007.06.007

Cited by 24 publications

(19 citation statements)

References 117 publications

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“…The treatment regimens for ITP include corticosteroids, intravenous immunoglobulin (IVIg), intravenous anti-D immunoglobulin, splenectomy, danazol and other immunosuppressive drugs. The mechanisms of current therapies include decreasing the accelerated platelet destruction by FcR blockade/activating and immunosuppression and enhancing platelet production [3]. Although treatment with prednisolone results in an increased platelet count in about 60-90% of adult patients, only 15-25% achieves a durable response.…”

Section: Introductionmentioning

confidence: 99%

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The efficacy of rituximab in patients with splenectomized refractory chronic idiopathic thrombocythopenic purpura

Paşa

Altıntaş

Çil

et al. 2008

J Thromb Thrombolysis

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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.

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Section: Introductionmentioning

confidence: 99%

“…In steroid refractory patients, a response is observed after splenectomy in approximately two-thirds of the patients. Most of the patients eventually become refractory to corticosteroids and splenectomy, as well as other available agents such as IVIg, danazol, or chemotherapy [3,4].…”

Section: Introductionmentioning

confidence: 99%

The efficacy of rituximab in patients with splenectomized refractory chronic idiopathic thrombocythopenic purpura

Paşa

Altıntaş

Çil

et al. 2008

J Thromb Thrombolysis

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“…Splenectomy is rarely performed in children given both the increased likelihood of spontaneous and/or therapyinduced remission and the increased infection-related morbidity and mortality [23]. Rituximab, a monoclonal anti-CD20 antibody, is an effective immunotherapeutic agent increasingly used to treat refractory ITP; however, its use is associated with infusion-related side effects [24,25], increased risk of the development of progressive multifocal leukoencephalopathy [26] and a greater incidence of infections [27].…”

Section: Treatment For Immune Thrombocytopeniamentioning

confidence: 99%

Eltrombopag: an update on the novel, non-peptide thrombopoietin receptor agonist for the treatment of immune thrombocytopenia

Kühne

Imbach

2010

Ann Hematol

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Immune thrombocytopenia (ITP) is characterised by a transient or persistent decrease in platelets accompanied by an increased risk of bleeding, which can have a significant negative impact on patients' health-related quality of life. The condition has long been associated with an increased rate of immune-mediated platelet destruction, and traditional treatments have targeted the reduction in platelet destruction; however, some interventional drugs are limited by transient efficacy and side effects. Recent advances in our understanding of ITP pathogenesis have highlighted the role of impaired platelet production, which has led to the advent of a new generation of thrombopoietin (TPO)-receptor agonist therapies, including eltrombopag and romiplostim. The oral, non-peptide TPO-receptor agonist eltrombopag has shown considerable promise in both preclinical and clinical trials. Eltrombopag has a unique mechanism of action and binds to a transmembrane region of the TPO receptor that is distant from the TPO binding site. As such, eltrombopag may confer synergistic effects with endogenous TPO rather than competing for binding. Eltrombopag also induces activation of the TPO receptor and downstream signalling in a distinct manner to TPO and does not have a significant impact on platelet function. Clinical evidence demonstrates that eltrombopag produces a rapid and sustainable increase in platelet counts that significantly reduces bleeding and is well tolerated in patients with ITP. Eltrombopag therefore represents an important addition to the therapeutic armamentarium for ITP.

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“…El uso del anticuerpo monoclonal anti CD20 (Rituximab), ha mostrado buenos resultados en el manejo de diferentes desordenes autoinmunes hematológicos y no hematológicos, entre ellos PTI (8)(9)(10)(11).…”

Section: Introductionunclassified

Efecto de un anticuerpo monoclonal anti CD20 (Rituximab) en trombocitopenia inmune.

Untama

Carpio

2012

Rev Med Hered

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Efecto de un anticuerpo monoclonal anti CD20 (Rituximab) en trombocitopenia inmune.Effect of an anti CD20 monoclonal antibody (Rituximab) in immune thrombocytopenia.José Untama, 1 Daniel Del Carpio. RESUMENObjetivo: Describir la respuesta terapéutica con un anticuerpo monoclonal anti CD20 (Rituximab), en pacientes con Trombocitopenia Inmune (PTI). Material y métodos: Estudio retrospectivo, descriptivo y observacional tipo serie de casos. Se revisaron las historias clínicas de pacientes adultos con PTI que recibieron el anticuerpo monoclonal anti CD20 (Rituximab), desde diciembre 2005 hasta diciembre 2010. Se definió respuesta: conteo plaquetario >30 mil, por lo menos duplicar el conteo plaquetario inicial y no signos de sangrado, y respuesta completa: conteo plaquetario >100 mil y no signos de sangrado. Resultados: Se evaluaron 24 cursos de tratamiento. Hubo respuesta en 18 (75%), en una media de 11,9 semanas (rango 0,7 -37,4), la duración media de respuesta fue 16 meses (rango 3,3 -55,3). Se mantuvo la respuesta obtenida en 12 pacientes, seguimiento promedio de 22 meses (rango 4 -62). Se logró respuesta completa en 13/23 (60%) casos, en una media de 17 semanas (rango 0,7 -62,3), con una duración media de respuesta completa de 10,1 meses (rango 2,3 -25,2), 5 casos mantuvieron respuesta completa con una media de seguimiento de 20 meses (rango 8 -29). Conclusiones: Se obtuvo una alta tasa de respuesta al tratamiento con Rituximab (hasta 75%) en casos de PTI que fallaron al menos a una línea de tratamiento.PALABRAS CLAVE: Púrpura trombocitopénica idiopática, anticuerpos. (Fuente: DeCS BIREME) SUMMARYObjective: To describe the therapeutic response of an anti CD20 monoclonal antibody (Rituximab) in patients with immune thrombocytopenia (ITT). Methods: Retrospective, descriptive and observational case series. The clinical charts of ambulatory patients with ITT who received Rituximab from December 2005 to December 2010 were reviewed. Response was defined as platelet count > 30 thousand, at least duplicate the initial platelet count and no evidence of bleeding, and complete response was defined as platelet count > 100 thousand and no evidence of bleeding. Results: 24 courses of treatment were evaluated. Response was obtained in 18 patients (75%); mean time to response was 11.9 weeks (range: 0,7 to 37.4); mean duration of response was 16 months (range: 3.3 to 55.3); 12 patients remained with the achieved response during a mean follow up of 22 months (range: 2.3 to 25.2). Complete response was obtained in 13/23 cases (60%); mean time to response was 17 weeks (range: 0.7 to 62,3); mean duration of response was 10,1 months (range: 2.3 to 25.2); 5 patients remained with complete response after a follow up of 20 months (range: 8-29). Conclusions: A high response rate was achieved with Rituximab (75%) in patients with ITT who had failed at least to one treatment.

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Rituximab treatment for chronic refractory idiopathic thrombocytopenic purpura

Cited by 24 publications

References 117 publications

The efficacy of rituximab in patients with splenectomized refractory chronic idiopathic thrombocythopenic purpura

The efficacy of rituximab in patients with splenectomized refractory chronic idiopathic thrombocythopenic purpura

Eltrombopag: an update on the novel, non-peptide thrombopoietin receptor agonist for the treatment of immune thrombocytopenia

Efecto de un anticuerpo monoclonal anti CD20 (Rituximab) en trombocitopenia inmune.

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