Abstract
We describe a 22-year-old male with idiopathic autoimmune thrombocytopenia whose diagnosis was made at age of eight. He underwent splenectomy at age ten and ITP recurred at age 21 with episodes of infection and severe neutropenia (absolute count around 170/μl). He showed no response to immunoglobulin, corticosteroids, danazol, cyclosporine and azathioprine. Anti-CD20 antibody was administered at a dose of 375 mg/m2 once a week for 2 weeks. After the second infusion of rituximab, the platelet count increased from 4,000 to 516,000/mm3 and neutrophils count raised from 180 to 545/mm3. The response improvement persisted during follow up for 9 months (neutrophil count 4,390/mm3). This observation indicates that B-cells may play a central role in the pathogenesis of ITN. Anti-CD20 antibody therapy may be an efficient treatment for the patients with chronic or recurrent ITN.
References
Calderwood S, Blanchette V, Doyle J, Freedman J, Stroncek D, Zipursky A (1994) Idiopathic thrombocytopenia and neutropenia in childhood. Am J Pediatr Hematol Oncol 16(2):95–101
George JN, El-Havake MA, Raskob GE (1995) Chronic idiopathic thrombocytopenic purpura. N Engl J Med 331:207
Bussel JB (2000) Overview of idiopathic thrombocytopenic purpura: new approach to refractory patients. Semin Oncol 27(6 Suppl 12):91
Saleh MN, Gutheil J, Moore M et al (2000) A pilot study of the anti-CD20 monoclonal antibody rituximab in patients with refractory immune thrombocytopenia. Semin Oncol 27(6 Suppl 12):99
Perotta A, Sunneberg TA, Scott J et al (1999) Rituxan in the treatment of chronic idiopathic thrombocytopenic purpura (ITP). Blood 94(Suppl 1):49a
Braendstrup P, Bjerrum OW, Nielsen OJ, Jensen BA, Clausen NT, Hansen PB, Andersen I, Schmidt K, Andersen TM, Peterslund NA, Birgens HS, Plesner T, Pedersen BB, Hasselbalch HC (2005) Rituximab chimeric anti-CD20 monoclonal antibody treatment for adult refractory idiopathic thrombocytopenic purpura. Am J Hematol 78(4):275–280
Peñalver FJ, Jiménez-Yuste V, Almagro M, Alvarez-Larrán A, Rodríguez L, Casado M, Gallur L, Giraldo P, Hernández R, Menor D, Rodríguez MJ, Caballero D, González R, Mayans J, Millán I, Cabrera JR (2006) Rituximab in the management of chronic immune thrombocytopenic purpura: an effective and safe therapeutic alternative in refractory patients. Ann Hematol 85(6):400–406
Tanai C, Iki S, Nakahara F, Iijima K, Usuki K, Kuwana M, Urabe A (2004) Effective treatment with rituximab in a patient with refractory idiopathic thrombocytopenic purpura. Rinsho Ketsueki 45(11):1181–1186 (In Japanese)
Stasi R, Pagano A, Stipa E, Amadori S (2001) Rituximab chimeric anti-CD20 monoclonal antibody treatment for adults with chronic idiopathic thrombocytopenic purpura. Blood 98(4):952–957
Moschovi M, Trimis G, Pergantou H, Platokouki H, Vrachnou E, Tzortzatou-Stathopoulou F (2005) Clinical remission following monoclonal anti-CD20 therapy in two children with chronic refractory idiopathic thrombocytopenic purpura. J Paediatr Child Health 41(7):384–386
Latifzadeh SZ, Entezari V (2006) Chronic refractory idiopathic thrombocytopenic purpura (ITP) and anti-CD20 monoclonal antibody: a case report. Clin Appl Thromb Hemost 12:489
Faurschou M, Hasselbalch HC, Nielsen OJ (2001) Sustained remission of platelet counts following monoclonal anti-CD20 antibody therapy in two cases of idiopathic autoimmune thrombocytopenia and neutropenia. Eur J Haematol 66(6):408
Heidel F, Lipka DB, von Auer C, Huber C, Scharrer I, Hess G (2007) Addition of rituximab to standard therapy improves response rate and progression-free survival in relapsed or refractory thrombotic thrombocytopenic purpura and autoimmune haemolytic anaemia. Thromb Haemost 97(2):228–233
Shanafelt TD, Madueme HL, Wolf RC, Tefferi A (2003) Rituximab for immune cytopenia in adults: idiopathic thrombocytopenic purpura, autoimmune hemolytic anemia, and Evans syndrome. Mayo Clin Proc 78(11):1340–1346
Capsoni F, Sarzi-Puttini P, Zanella A (2005) Primary and secondary autoimmune neutropenia. Arthritis Res Ther 7(5):208–214
Shastri KA, Logue GL (1993) Autoimmune neutropenia. Blood 81:1984–1995
Killick SB, Marsh JC, Hale G, Waldmann H, Kelly SJ, Gordon-Smith EC (1997) Sustained remission of severe resistant autoimmune neutropenia with Campath-1H. Br J Haematol 97:306–308. doi:10.1046/j.1365-2141.1997.612718.x
Marsh JC, Gordon-Smith EC (2001) CAMPATH-1H in the treatment of autoimmune cytopenias. Cytotherapy 3:189–195. doi:10.1080/146532401753174133
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Maleki, D., van der Meer, M. & Eghbal, M.P. Successful Treatment of Refractory Idiopathic Thrombocytopenic Purpura and Neutropenia with the Monoclonal Antibody, Rituximab. Indian J Hematol Blood Transfus 28, 114–116 (2012). https://doi.org/10.1007/s12288-011-0099-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12288-011-0099-6