Rituximab and three dexamethasone cycles provide responses similar to splenectomy in women and those with immune thrombocytopenia of less than two years duration
Rituximab and three dexamethasone cycles provide responses similar to splenectomy in women and those with immune thrombocytopenia of less than two years duration
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DOI：
10.3324/haematol.2013.103291
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发表时间：
2014-07-01
期刊：
影响因子：
10.1
通讯作者：
Ghanima, Waleed
中科院分区：
文献类型：
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作者：
Bussel, James B.;Lee, Christina S.;Ghanima, Waleed
新诊断的或持续性免疫性血小板减少症的成人在逐渐减少的类固醇后经常复发;患有慢性疾病的成人和儿童持久反应的可能性更低。在新诊断的免疫性血小板减少症成人中，两项研究显示地塞米松40 mg/天× 4天和4次利妥昔单抗输注上级地塞米松单药。研究还表明，三个周期的地塞米松优于一个周期，持续性/慢性免疫性血小板减少症患者对地塞米松或利妥昔单抗的反应较差。因此，375 mg/m2 × 4利妥昔单抗与三个4天周期的28 mg/m2（最大）相结合。40 mg）地塞米松，间隔2周，并在67例ITP患者中进行了探索。最佳长期缓解评估为完全缓解（血小板计数≥ 100 × 10（9）/L）或部分缓解（50- 99 × 10（9）/L）。只有5名患者以前没有接受过治疗。50例患者达到完全缓解（n=43，64%）或部分缓解（n=7，10%）。在中位17个月（范围4-67）时，50例应答者中有35例的无治疗血小板计数维持在50 × 10（9）/L以上，预计无事件生存率为44%。免疫性血小板减少持续时间小于24个月、达到完全缓解、女性与较好的长期缓解相关（P
Adults with newly diagnosed or persistent immunothrombocytopenia frequently relapse upon tapering steroids; adults and children with chronic disease have an even lower likelihood of lasting response. In adults with newly-diagnosed immunothrombocytopenia, two studies showed that dexamethasone 40 mg/day x four days and 4 rituximab infusions were superior to dexamethasone alone. Studies have also shown three cycles of dexamethasone are better than one and patients with persistent/chronic immunothrombocytopenia respond less well to either dexamethasone or rituximab. Therefore, 375 mg/m(2) x 4 rituximab was combined with three 4-day cycles of 28 mg/m2 (max. 40 mg) dexamethasone at 2-week intervals and explored in 67 ITP patients. Best long-term response was assessed as complete (platelet count >= 100x10(9)/L) or partial (50-99x10(9)/L). Only 5 patients had not been previously treated. Fifty achieved complete (n=43, 64%) or partial (n=7, 10%) responses. Thirty-five of 50 responders maintained treatment-free platelet counts over 50x10(9)/L at a median 17 months (range 4-67) projecting 44% event-free survival. Duration of immunothrombocytopenia less than 24 months, achieving complete responses, and being female were associated with better long-term response (P