Bruserud Øyvind, Håvardstein Kathrine
Section for Hematology, Department of Medicine, Haukeland University Hospital, Bergen N-5021, Norway.
Hematology. 2009 Aug;14(4):224-6. doi: 10.1179/102453309X439782.
Rituximab and mycophenolate mofetil are used in the treatment of resistant immune thrombocytopenic purpura (ITP). Both therapeutic approaches can induce responses in subsets of patients, but these responses are usually of limited duration and often lasting for less than one year. Mycophenolate mofetil 250 mg twice daily was insufficient to induce a prolonged response. In this article, we describe a patient with severe chronic ITP that was treated with rituximab. The platelet count started to decrease 5 months after rituximab therapy, low dose therapy with mycophenolate mofetil 250 mg twice daily was then started and peripheral blood platelet counts then stabilized between 70 and 100 x 10(9)/l. Mycophenolate mofetil could later be reduced to 250 mg once daily, and the patient has now had stable platelet counts for more than 4 years. Thus, the previous mycophenolate mofetil treatment that was insufficient to induce a prolonged response could maintain a prolonged response after rituximab therapy. This observation suggests that mycophenolate mofetil can be used to prolong responses after rituximab therapy for ITP.
利妥昔单抗和霉酚酸酯用于治疗难治性免疫性血小板减少性紫癜（ITP）。这两种治疗方法均可在部分患者中诱导缓解，但这些缓解通常持续时间有限，往往不到一年。每日两次250毫克的霉酚酸酯不足以诱导出持久的缓解。在本文中，我们描述了一名接受利妥昔单抗治疗的重度慢性ITP患者。利妥昔单抗治疗5个月后血小板计数开始下降，随后开始每日两次250毫克的低剂量霉酚酸酯治疗，外周血血小板计数随后稳定在70至100×10⁹/L之间。霉酚酸酯后来可减至每日一次250毫克，该患者目前血小板计数稳定已超过4年。因此，先前不足以诱导持久缓解的霉酚酸酯治疗在利妥昔单抗治疗后可维持持久缓解。这一观察结果表明，霉酚酸酯可用于延长利妥昔单抗治疗ITP后的缓解时间。
