B-cell depletion with rituximab as treatment for immune hemolytic anemia and chronic thrombocytopenia.
Francesco Zaja,I. Iacona,Paola Masolini,Domenico Russo,Alessandra Sperotto,Simonetta Prosdocimo,Francesca Patriarca,de Vita S,Mario Regazzi,Michele Baccarani,R Fanin +10 more
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TL;DR: Rituximab appeared to be active and safe in some patients with refractory autoimmune hemolytic anemia and thrombocytopenia, and data from literature suggest that this agent may have a therapeutic role in autoimmune diseases.
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Abstract: BACKGROUND AND OBJECTIVES: Rituximab reacts specifically with the CD20 antigen and induces B-cell depletion. This could interfere with the production of autoantibodies in some immune diseases. The objective of this study was to assess the effects of rituximab in autoimmune hemolytic anemia and thrombocytopenia. DESIGN AND METHODS: Seven patients (one with cold agglutinin disease, two with warm antibody autoimmune hemolytic anemia, four with chronic idiopathic thrombocytopenic purpura) previously refractory to conventional treatments were treated with weekly infusions of rituximab, 375 mg/m2, for 4 weeks. Only treatment with steroids, if strictly necessary, was allowed during the period of rituximab administration, but only patients who reached steroid suspension were considered responders. The pharmacokinetics of rituximab were quantified during therapy and the follow-up period. RESULTS: All patients had marked, even if temporary, B-cell depletion. Three patients, 1 with cold agglutinin disease (CAD) and 2 with chronic idiopathic thrombocytopenic purpura (ITP), had a complete hematologic response. In the patient with cold agglutinin disease a decrease in the agglutinin titer was observed. The hematologic improvement was prompt, appearing by the second or third infusion of rituximab. The response duration was CAD 96+, ITP 17+ and 13+ weeks in these 3 patients. Treatment tolerance was satisfactory and no infections or other late events were registered. Serum rituximab concentrations appeared to be similar to those calculated in a historical control group of patients with follicular non-Hodgkin's lymphoma who received rituximab as consolidation of response after first-line CHOP chemotherapy. INTERPRETATION AND CONCLUSIONS: Rituximab appeared to be active and safe in some patients with refractory autoimmune hemolytic anemia and thrombocytopenia. These results, along with data from literature, suggest that this agent may have a therapeutic role in autoimmune diseases.
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Citations
Patent
Immunoglobulin variants and uses thereof
Camellia W. Adams,Andrew C. Chan,Craig W. Crowley,Henry B. Lowman,Gerald R. Nakamura,Leonard G. Presta +5 more
- 16 Dec 2003
TL;DR: In this paper, humanized and chimeric anti-CD20 antibodies for treatment of CD20 positive malignancies and autoimmune diseases were provided for the treatment of cancer and other diseases.
678
Rituximab therapy and autoimmune disorders: prospects for anti-B cell therapy
TL;DR: The clinical potential of CD20-targeted therapy derives, in large part, from the unexpected finding that treatment with an antibody to CD20 induces the death of B lymphocytes, even without the need to conjugate the antibody to a toxin.
390
How I treat autoimmune hemolytic anemias in adults
Klaus Lechner,Ulrich Jäger +1 more
TL;DR: Currently, splenectomy can be regarded as the most effective and best-evaluated second-line therapy, but there are still only limited data on long-term efficacy and adverse effects.
341
Outcomes 5 years after response to rituximab therapy in children and adults with immune thrombocytopenia.
Vivek Patel,Matthieu Mahévas,Soo Y. Lee,Roberto Stasi,Susanna Cunningham-Rundles,Bertrand Godeau,Julie Kanter,Ellis J. Neufeld,Tillmann Taube,Ugo Ramenghi,Shalini Shenoy,Mary J. Ward,Nino Mihatov,Vinay L. Patel,Philippe Bierling,Martin Lesser,Nichola Cooper,James B. Bussel +17 more
TL;DR: Only 21% to 26% of adults and children with chronic ITP treated with standard-dose rituximab maintained a treatment-free response for at least 5 years without major toxicity, which can inform clinical decision-making.
327
Rituximab for the treatment of refractory autoimmune hemolytic anemia in children
Marco Zecca,Bruno Nobili,Ugo Ramenghi,Silverio Perrotta,Giovanni Amendola,Pasquale Rosito,Momcilo Jankovic,Paolo Pierani,Piero De Stefano,Mario Regazzi Bonora,Franco Locatelli +10 more
TL;DR: The data indicate that rituximab is both safe and effective in reducing or even abolishing hemolysis in children with AIHA and that a sustained response can be achieved in the majority of cases.
296
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I. Iacona,Mario Lazzarino,Maria Antonietta Avanzini,Maurizio Rupolo,Luca Arcaini,Cesare Astori,Francesca Lunghi,Ester Orlandi,Enrica Morra,Vittorina Zagonel,Mario Regazzi +10 more
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