International Journal of Hematology

, Volume 84, Issue 1, pp 48–53 | Cite as

Rituximab (anti-cd20 monoclonal antibody) in children with chronic refractory symptomatic immune thrombocytopenic purpura: efficacy and safety of treatment

  • Emilia Parodi
  • Bruno Nobili
  • Silverio Perrotta
  • Sofia Maria Rosaria Matarese
  • Giovanna Russo
  • Maria Licciardello
  • Marco Zecca
  • Franco Locatelli
  • Simone Cesaro
  • Gianni Bisogno
  • Paola Giordano
  • Domenico De Mattia
  • Ugo Ramenghi
Progress in Hematology

Abstract

This retrospective study investigated the effects of rituximab in 19 pediatric patients (15 girls and 4 boys) with chronic refractory symptomatic immune thrombocytopenic purpura (ITP). Patients received from 2 to 5 weekly infusions of rituximab (375 mg/m2); 15 patients were younger than 12 years when treated. The median follow-up time was 30 months (range, 9–43 months). The overall response rate was 68% (13/19 patients). Six responders relapsed at a median of 4.5 months (range, 3–8 months). Seven patients still displayed a platelet count >150,000/μL at a median of 33 months (range, 14-43 months) after rituximab treatment. Six of 15 patients treated with 4 or 5 weekly infusions and 1 of 4 patients treated with 2 or 3 infusions are still in remission. No difference was detected between splenectomized and nonsplenectomized patients. The duration of ITP disease at the time of treatment did not influence the response rate. Patients still in remission showed significantly lower levels of CD19+ cells after 4 and 6 months than nonresponding or relapsed patients (P < .05). No major infections were reported during follow-up. Our data show the efficacy and tolerability of rituximab in young children with refractory symptomatic ITP. Nonrelapsed patients showed a more prolonged B-cell depletion.

Key words

Immune thrombocytopenic purpura Children Rituximab 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med. 2002;346:995–1008.PubMedCrossRefGoogle Scholar
  2. 2.
    Perrotta S, Amendola G, Locatelli F, et al. Treatment with shortterm, high-dose cyclosporin A in children with refractory chronic idiopathic thrombocytopenic purpura. Br J Haematol. 2003;121:143–147.PubMedCrossRefGoogle Scholar
  3. 3.
    Maloney DG, Grillo-Lopez AJ, White CA, et al. IDEC-C2B8 (rituximab) anti-CD20 monoclonal antibody therapy in patients with relapsed low-grade non-Hodgkin’s lymphoma. Blood. 1997;90:2188–2195.PubMedGoogle Scholar
  4. 4.
    Ahrens N, Kingreen D, Seltsam A, Salama A. Treatment of refractory autoimmune haemolytic anaemia with anti-CD20 (rituximab). Br J Haematol. 2001;114:244–245.PubMedCrossRefGoogle Scholar
  5. 5.
    Arzoo K, Sadeghi S, Liebman HA. Treatment of refractory antibody mediated autoimmune disorders with an anti-CD20 monoclonal antibody (rituximab). Ann Rheum Dis. 2002;61:922–924.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Kneitz C, Wilhelm M, Tony HP. Effective B cell depletion with rituximab in the treatment of autoimmune diseases. Immunobiology. 2002;206:519–527.PubMedCrossRefGoogle Scholar
  7. 7.
    Stasi R, Pagano A, Stipa E, Amadori S. Rituximab chimeric anti CD20 monoclonal antibody treatment for adults with chronic idiopathic thrombocytopenic purpura. Blood. 2001;98:952–957.PubMedCrossRefGoogle Scholar
  8. 8.
    Giagounidis AA, Anhuf J, Schneider P, et al. Treatment of relapsed idiopathic thrombocytopenic purpura with the anti CD-20 monoclonal antibody rituximab: a pilot study. Eur J Haematol. 2002;69:95–100.PubMedCrossRefGoogle Scholar
  9. 9.
    Stasi R, Stipa E, Forte V, Meo P, Amadori S. Variable patterns of response to rituximab treatment in adults with chronic idiopathic thrombocytopenic purpura. Blood. 2002;99:3872–3873.PubMedCrossRefGoogle Scholar
  10. 10.
    Zaja F, Iacona I, Masolini P, et al. B cell depletion with rituximab as treatment for immune hemolytic anemia and chronic thrombocytopenia. Haematologica. 2002;87:189–195.PubMedGoogle Scholar
  11. 11.
    Cooper N, Stasi R, Cunningham-Rundles S, et al. The efficacy and safety of B-cell depletion with anti-CD20 monoclonal antibody in adults with chronic immune thrombocytopenic purpura. Br J Haematol. 2004;125:232–239.PubMedCrossRefGoogle Scholar
  12. 12.
    Quartier P, Brethon B, Philippet P, Landman-Parker J, Le Deist F, Fischer A. Treatment of childhood autoimmune haemolytic anemia with rituximab. Lancet. 2001;358:1511–1513.PubMedCrossRefGoogle Scholar
  13. 13.
    Zecca M, Nobili B, Ramenghi U, et al. Rituximab for the treatment of refractory autoimmune hemolytic anemia in children. Blood. 2003;101:3857–3861.PubMedCrossRefGoogle Scholar
  14. 14.
    Bengston KL, Skinner MA, Ware RE. Successful use of anti-CD20 (rituximab) in severe, life threatening childhood immune thrombocytopenic purpura. J Pediatr. 2003;143:670–673.CrossRefGoogle Scholar
  15. 15.
    Pusiol A, Cesaro S, Nocerino A, Picco G, Zanesco L, Bisogno G. Successful treatment with the monoclonal antibody rituximab in two children with refractory autoimmune thrombocytopenia. Eur J Pediatr. 2004;163:305–307.PubMedCrossRefGoogle Scholar
  16. 16.
    Russo G, Licciardello M, La Spina M. Rituximab in children with idiopathic thrombocytopenic purpura: does it really work? Eur J Pediatr. 2004;163:569.PubMedCrossRefGoogle Scholar
  17. 17.
    Taube T, Schmid H, Reinhard H, von Stackelberg A, Overberg US. Effect of a single dose of rituximab in chronic immune thrombocytopenic purpura in childhood. Haematologica. 2005;90:281–283.PubMedGoogle Scholar
  18. 18.
    Wang J, Wiley JM, Luddy R, Greenberg J, Feuerstein MA, Bussel JB. Chronic immune thrombocytopenic purpura in children: assessment of rituximab treatment. J Pediatr. 2005;146:217–221.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society of Hematology 2006

Authors and Affiliations

  • Emilia Parodi
    • 1
  • Bruno Nobili
    • 2
  • Silverio Perrotta
    • 2
  • Sofia Maria Rosaria Matarese
    • 2
  • Giovanna Russo
    • 3
  • Maria Licciardello
    • 3
  • Marco Zecca
    • 4
  • Franco Locatelli
    • 4
  • Simone Cesaro
    • 5
  • Gianni Bisogno
    • 5
  • Paola Giordano
    • 6
  • Domenico De Mattia
    • 6
  • Ugo Ramenghi
    • 1
  1. 1.Pediatric DepartmentUniversity of TorinoTorino
  2. 2.Pediatric DepartmentII University of NapoliNapoli
  3. 3.Pediatric DepartmentUniversity of CataniaCatania
  4. 4.Pediatric DepartmentUniversity of PaviaPavia
  5. 5.Pediatric DepartmentUniversity of PadovaPadova
  6. 6.Pediatric DepartmentUniversity of BariBariItaly

Personalised recommendations