Vinayek Namita, Sharma Vivek
University of Louisville, 529 South Jackson Street, Louisville, Kentucky 40202, USA.
J Med Case Rep. 2014 Jan 15;8:19. doi: 10.1186/1752-1947-8-19.
Chronic refractory immune thrombocytopenic purpura can be a challenging condition to treat. By definition, the standard first and second line treatments have failed in these patients and modalities such as thrombopoiesis-stimulating agents and more intensive immunosuppressive drugs are therefore used. However, there still remains a subset of patients who continue to be refractory to treatment.
We present the case of a 30-year-old Hispanic woman with recurrent intracranial bleeds, in whom multiple lines of treatment had failed. She was treated with a combination of bortezomib and rituximab based on previously published data that suggested this therapy effectively blocks all antibody-producing cells. Our patient's platelet counts rapidly improved and subsequently normalized following this treatment.
To the best of our knowledge, this case represents the first report of the effective use of bortezomib and rituximab in highly refractory immune thrombocytopenic purpura. We believe further study of this therapy is warranted in this setting.
慢性难治性免疫性血小板减少性紫癜可能是一种具有挑战性的疾病，难以治疗。根据定义，这些患者的标准一线和二线治疗均告失败，因此会使用诸如血小板生成素刺激剂和更强效的免疫抑制药物等治疗方式。然而，仍有一部分患者对治疗持续无效。
我们报告了一名30岁西班牙裔女性的病例，她反复出现颅内出血，多种治疗方法均告失败。基于此前发表的数据表明这种疗法可有效阻断所有产生抗体的细胞，她接受了硼替佐米和利妥昔单抗联合治疗。接受该治疗后，我们患者的血小板计数迅速改善，随后恢复正常。
据我们所知，本病例是硼替佐米和利妥昔单抗有效用于高度难治性免疫性血小板减少性紫癜的首例报告。我们认为有必要在此背景下对该疗法开展进一步研究。
