Response of refractory immune thrombocytopenic purpura in a patient with common variable immunodeficiency to treatment with rituximab

High-dose IVIG first established itself as an immunomodulatory agent in the treatment of ITP, although its use is usually limited to patients in whom corticosteroids have failed or who have clinical features of haemorrhage. 3 Splenectomy is often effective and results in cure in up to 75% of patient...

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Bibliographic Details
Published in:Journal of clinical pathology 2007-06, Vol.60 (6), p.715-716
Main Authors: El-Shanawany, T M, Williams, P E, Jolles, S
Format: Article
Language:English
Subjects:
Aged
Antibodies, Monoclonal - therapeutic use
Antibodies, Monoclonal, Murine-Derived
Antigens, CD20 - immunology
Autoimmune diseases
Biological and medical sciences
Blood platelets
Case Reports
Common Variable Immunodeficiency - complications
Female
Follow-Up Studies
Granulocytes
Hematologic and hematopoietic diseases
Humans
Immunoglobulins
Immunoglobulins, Intravenous - therapeutic use
Immunosuppressive Agents - therapeutic use
Investigative techniques, diagnostic techniques (general aspects)
Lymphoma
Medical sciences
Neutropenia
Neutrophils
Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques
Platelet diseases and coagulopathies
Purpura, Thrombocytopenic, Idiopathic - drug therapy
Purpura, Thrombocytopenic, Idiopathic - etiology
Rituximab
Treatment Outcome
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Summary:High-dose IVIG first established itself as an immunomodulatory agent in the treatment of ITP, although its use is usually limited to patients in whom corticosteroids have failed or who have clinical features of haemorrhage. 3 Splenectomy is often effective and results in cure in up to 75% of patients. 4 Rituximab is an anti-CD20 humanised monoclonal antibody that causes temporary B cell depletion. 5 The mechanisms of action include complement activation, antibody-dependent cell-mediated cytotoxicity and direct effects on B cells mediated via CD20 binding. 6 Rituximab is licensed for the treatment of B cell non-Hodgkin's lymphoma, where it is used at a dose of 375 mg/m2 weekly for four consecutive weeks. A number of other questions remain, such as whether the full dose of 375 mg/m2 used to treat B cell non-Hodgkin's lymphoma is also required for ITP, or whether a lower dose would still provide the same clinical benefit.
ISSN:0021-9746
1472-4146
DOI:10.1136/jcp.2006.041426