Zhou Hu, Liu Liu, Shu Xinhui, Wang Xiaoran, Song Yongping
Department of Hematology, Affiliated Tumor Hospital of Zhengzhou University, Tumor Hospital of Henan Province, Institute of Hematology of Henan Province, 127 Dongming Road, Zhengzhou, 450000 People's Republic of China.
2Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.
Indian J Hematol Blood Transfus. 2019 Jul;35(3):507-512. doi: 10.1007/s12288-018-1061-7. Epub 2019 Jan 1.
Standard-dose prednisone as first-line therapy for primary immune thrombocytopenia (ITP) can not obtain high long-term responses. Results from high-dose dexamethasone course administered in adult newly diagnosed ITP were promising. The role of standard-dose rituximab in first-line treatment of newly diagnosed ITP were also investigated. We retrospectively analyzed the efficacy and safety of high-dose dexamethasone plus low-dose (100 mg/w) rituximab for treatment of adults newly diagnosed ITP. A total of eighteen patients received dexamethasone 40 mg/day for 4 consecutive days (days + 1 to + 4), rituximab 100 mg once weekly for a total of 4 weeks (days + 7, + 14, + 21 and + 28). Non-responders accepted the repeated dexamethasone treatment every 2 weeks for a total of up to 3 treatment cycles. The overall response was 100% at 28th day. Median follow-up was 17 months (1-33 months). Six patients (33.3%) relapsed. Sustained complete response or response after 6 months and 12 months of follow-up were reached in 83.3% (15/18) and 61.5% (8/13) of patients respectively. The 12-month and 15-month cumulative relapse-free survival were 69.3% and 60.7%. Incidence of adverse effects was 11.1% (2/18). High-dose dexamethasone plus low-dose rituximab therapy had high efficacy and well tolerability as first-line treatment option in newly diagnosed ITP.
标准剂量泼尼松作为原发性免疫性血小板减少症（ITP）的一线治疗方案无法获得较高的长期缓解率。在成年初诊ITP患者中应用大剂量地塞米松疗程的结果令人满意。同时也研究了标准剂量利妥昔单抗在初诊ITP一线治疗中的作用。我们回顾性分析了大剂量地塞米松联合低剂量（100mg/周）利妥昔单抗治疗成年初诊ITP的疗效和安全性。共有18例患者接受地塞米松40mg/天，连续4天（第+1至+4天），利妥昔单抗100mg每周1次，共4周（第+7、+14、+21和+28天）。无反应者每2周接受重复地塞米松治疗，最多3个治疗周期。第28天时总缓解率为100%。中位随访时间为17个月（1 - 33个月）。6例患者（33.3%）复发。随访6个月和12个月时分别有83.3%（15/18）和61.5%（8/13）的患者达到持续完全缓解或缓解。12个月和15个月的累积无复发生存率分别为69.3%和60.7%。不良反应发生率为11.1%（2/18）。大剂量地塞米松联合低剂量利妥昔单抗治疗作为初诊ITP的一线治疗方案具有高效和良好的耐受性。
