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Rituximab in the management of chronic immune thrombocytopenic purpura: an effective and safe therapeutic alternative in refractory patients

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An Erratum to this article was published on 13 May 2006

An Erratum to this article was published on 13 May 2006

Abstract

Rituximab induces B-cell depletion; therefore, it has been used in the treatment of immune thrombocytopenic purpura (ITP). The aim of this retrospective study was to evaluate the effectiveness of rituximab in the treatment of 89 patients with chronic ITP refractory to several treatments. All the patients had platelet counts <30×109/l. They had received a median of five (2–13) previous treatments, and 47 had undergone splenectomy. Rituximab was administered i.v. at 375 mg/m2 in four weekly doses in 77 patients, and 12 patients received 1–6 doses. Forty-nine patients (55.1%) reached platelet counts >50×109/l; 41 (46%) achieved a complete response (CR; platelets >100×109/l), and eight (9%) obtained a partial response (platelets 50–100×109/l). Overall, 31 patients (35%) maintained response, including 15 patients in whom splenectomy failed, with a median follow-up of 9 months (2–42), 12 for more than 1 year. The unique predictor of a maintained response was to reach a CR. Heavily treated patients (more than three different previous treatments, including any corticosteroids) and those with longer ITP duration (>10 years from diagnosis) had a worse response. Non-splenectomized patients had a better early response rate than those splenectomized. Rituximab was well tolerated, with two fever episodes following infusion and two reports of skin rash. Rituximab induced clinical responses in multi-treated refractory ITP patients with little toxicity and should be considered as an early therapeutic option in this setting, even as an alternative to splenectomy in selected patients.

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Acknowledgements

Members of the Spanish Study Group on the use of rituximab in refractory ITP: Rosalía Bustelos, Hospital Universitario 12 de Octubre, Madrid; Carmen Fernández-Miñano, Hospital Vega Baja de Orihuela, Alicante ; Secundino Ferrer, Hospital Doctor Peset, Valencia; Consuelo Funes, Hospital Santa María de Rosell de Cartagena, Murcia; María Carmen García, Hospital General de Elda, Alicante; María Luisa Martín, Hospital San Pedro de Alcántara, Cáceres; Enrique Mut, Hospital General Universitario de Alicante; Alicia Bailén, Hospital Carlos Haya, Málaga; Rosa María Campos, Hospital del SAS de Jeréz de la Frontera, Cádiz; Ana Carral, Hospital de Sagunto, Valencia; Carlos Cerveró, Hospital Virgen de la Luz, Cuenca; Carlos Clavero, Hospital Torre-Cárdenas, Almería; Joaquín Díaz-Mediavilla, Hospital Clínico San Carlos, Madrid; Jose María Durán, Hospital del SAS de La Línea de la Concepción, Cádiz; Víctor Echeverría, Hospital Universitario Gregorio Marañón, Madrid; María Ángeles Fernández, Hospital Virgen del Puerto de Plasencia, Cáceres; Julio García-Suárez, Hospital Príncipe de Asturias de Alcalá de Henares, Madrid; María Guinot, Hospital General de Castellón; Magdalena Herrera, Hospital Nuestra Señora. de la Candelaria, Tenerife; Isidro Jarque, Hospital Universitario La Fé, Valencia; Antonio Cerveró, Hospital General de Valencia; Francisca Marín, Hospital de Elche, Alicante; María José Moreno, Hospital Clínico Virgen de la Victoria, Málaga; Miquel Morey, Hospital Son Dureta, Palma de Mallorca; José Nieto, Hospital Morales Meseguer, Murcia; Isabel Picón, Fundación Instituto Valenciano de Oncología, Valencia; Eduardo Ríos, Hospital Virgen del Rocío, Sevilla; Juan Nicolás Rodríguez, Hospital Juan Ramón Jiménez, Huelva; Jorge Sánchez-Guilarte, Hospital de Móstoles, Madrid. The authors gratefully acknowledge Dra. María Jesús Fernández-Aceñero for her support and critical reviewing of the manuscript.

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Authors and Affiliations

  1. Fundación Hospital Alcorcón, Madrid, Spain

    Francisco Javier Peñalver

  2. Hospital La Paz, Madrid, Spain

    Victor Jiménez-Yuste

  3. Hospital Virgen de las Nieves, Granada, Spain

    Manuel Almagro

  4. Hospital Clinic, Barcelona, Spain

    Alberto Alvarez-Larrán

  5. Hospital Germans Trias y Pujol, Badalona, Spain

    Lluis Rodríguez

  6. Hospital Infanta Cristina, Badajoz, Spain

    Marisol Casado

  7. Hospital Vall D` Hebron, Barcelona, Spain

    Laura Gallur

  8. Hospital Miguel Servet, Zaragoza, Spain

    Pilar Giraldo

  9. Hospital de Txagoritxu, Vitoria, Spain

    Roberto Hernández

  10. Hospital de Getafe, Madrid, Spain

    Dolores Menor

  11. Hospital Universitario de Canarias, Tenerife, Spain

    Maria José Rodríguez

  12. Hospital Clínico de Salamanca, Salamanca, Spain

    Dolores Caballero

  13. Hospital Sant Joan, Alicante, Spain

    Raúl González

  14. Hospital Arnau de Vilanova, Valencia, Spain

    José Mayans

  15. Biostatistics Department, Clínica Puerta de Hierro, Madrid, Spain

    Isabel Millán

  16. Hematology Department, Hospital Universitario Puerta de Hierro, San Martin de Porres 4, 28035, Madrid, Spain

    José Rafael Cabrera

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  1. Francisco Javier Peñalver
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  2. Victor Jiménez-Yuste
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  3. Manuel Almagro
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  7. Laura Gallur
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  9. Roberto Hernández
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  13. Raúl González
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  14. José Mayans
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  15. Isabel Millán
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  16. José Rafael Cabrera
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On behalf of the Multi-institutional Retrospective Spanish Study on the use of rituximab in refractory ITP

Corresponding author

Correspondence to José Rafael Cabrera.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00277-006-0123-3

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On behalf of the Multi-institutional Retrospective Spanish Study on the use of rituximab in refractory ITP., Peñalver, F.J., Jiménez-Yuste, V. et al. Rituximab in the management of chronic immune thrombocytopenic purpura: an effective and safe therapeutic alternative in refractory patients. Ann Hematol 85, 400–406 (2006). https://doi.org/10.1007/s00277-005-0073-1

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  • DOI: https://doi.org/10.1007/s00277-005-0073-1

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