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Rituximab Promising As Salvation Therapy For Immune Cytopenias

Rituximab deserves early consideration as salvage therapy for immune cytopenias that are refractory to both corticosteroid treatment and splenectomy, say researchers at the Mayo Clinic in Rochester, Minnesota, United States.

Immune cytopenias affect 14 million individuals in the United States. Idiopathic thrombocytopenia purpura (ITP) and autoimmune haemolytic anaemia (AIHA), immune cytopenias characterised by antibody-mediated destruction of haematologic cells, respond to corticosteroid treatment in most adult patients.

However, the majority of patients with ITP and AIHA relapse during corticosteroid taper, and many require splenectomy or therapy with immunosuppressive agents.

Rituximab, a chimeric murine/human anti-CD20 antibody, has been studied previously as treatment for various antibody-mediated autoimmune disorders, including ITP and AIHA. To further evaluate rituximab efficacy, Tait D. Shanafelt, MD, and colleagues retrospectively reviewed the medical charts of 14 adult patients who received 1 or more treatment courses of rituximab for immune cytopenia.

Among the patients, 12 were treated for refractory ITP, 5 for AIHA, and 4 had both ITP and AIHA (classified as Evans syndrome) at some point during follow up. Data collected for analysis included age, diagnosis, date of diagnosis, previous treatments, comorbid conditions, blood cell counts prior to rituximab treatment, number of rituximab treatments, and treatment response.

Results showed that complete remission was achieved with rituximab therapy in 42% of patients with ITP and 40% of patients with AIHA. In patients with Evans syndrome, treatment response was observed in either ITP or AIHA, but not both.

In 3 patients with ITP, complete response continued through the follow up period (7, 10, and 11 months) with no additional treatment. In AIHA patients, all patients achieving complete response maintained remission through follow up (4 and 13 months) with no additional treatment.

The researchers note that the retrospective nature of the study prevented the assessment of frequency and severity of adverse reactions to rituximab.

"Our results confirm the efficacy of rituximab for a broad range of immune cytopenias," conclude the researchers. "Prospective controlled trials are needed to answer key questions regarding response predictors, optimal dose and schedule, the role of combination therapy, and the role of rituximab as frontline therapy for autoimmune cytopenias."

Mayo Clin Proc 2003 Nov;78:11:1340-6. "Rituximab for immune cytopenia in adults: idiopathic thrombocytopenic purpura, autoimmune hemolytic anemia, and Evans syndrome"

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