Pasa Semir, Altintas Abdullah, Cil Timucin, Danis Ramazan, Ayyildiz Orhan
Department of Hematology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey.
J Thromb Thrombolysis. 2009 Apr;27(3):329-33. doi: 10.1007/s11239-008-0208-z. Epub 2008 Mar 3.
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.
医生所面临的最棘手问题是对患有特发性血小板减少性紫癜（ITP）的患者进行治疗，这些患者在初次使用糖皮质激素和脾切除治疗失败后仍存在持续性严重血小板减少。大多数对糖皮质激素和脾切除治疗无效的患者对其他可用药物，如静脉注射免疫球蛋白（IVIg）、达那唑或化疗也会产生耐药。在本研究中，我们调查了利妥昔单抗对17例脾切除术后难治性慢性ITP患者的疗效。在此，我们表明抗CD20抗体利妥昔单抗可在对其他治疗方案无反应的严重慢性ITP患者中诱导出具有临床意义的反应。六个月后，14例有反应的患者中有10例仍维持持久且显著的血小板反应（血小板计数>50×10⁹/L），无需使用任何其他ITP药物。因此，我们认为，利妥昔单抗是脾切除术后难治性或复发性ITP患者的一种有效治疗选择。利妥昔单抗耐受性良好，无严重副作用。
