Repeated courses of rituximab in chronic ITP: Three different regimens

Authors

  • Aisha Hasan,

    Corresponding author
    1. Division of Pediatric Hematology, Children's Blood Center, NY Presbyterian Hospital and Weill Cornell Medical College, New York, New York
    • Division of Pediatric Hematology and Oncology, NY Presbyterian Hospital and Weill Cornell Medical Center and Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021
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  • Marc Michel,

    1. Department of Medicine, Division of Hematology, Hôpital Henri Mondor, Assistance-Publique Hôpitaux de Paris, Paris, France
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  • Vivek Patel,

    1. Division of Pediatric Hematology, Children's Blood Center, NY Presbyterian Hospital and Weill Cornell Medical College, New York, New York
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  • Roberto Stasi,

    1. Department of Haematology, St. George's Hospital, London, UK
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  • Susanna Cunningham-Rundles,

    1. Division of Pediatric Hematology, Children's Blood Center, NY Presbyterian Hospital and Weill Cornell Medical College, New York, New York
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  • John P. Leonard,

    1. Division of Hematology, NY Presbyterian Hospital and Weill Cornell Medical College, New York, New York
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  • James Bussel

    1. Division of Pediatric Hematology, Children's Blood Center, NY Presbyterian Hospital and Weill Cornell Medical College, New York, New York
    2. Division of Hematology, NY Presbyterian Hospital and Weill Cornell Medical College, New York, New York
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  • Conflict of interest: Nothing to report.

Abstract

This study investigated responses to retreatment with rituximab in chronic immune thrombocytopenic purpura (ITP) patients. Treatment with rituximab in chronic ITP patients induces long-lasting responses in ∼30% of patients but even these patients may relapse. Twenty patients who had achieved a response to rituximab and relapsed were retreated with rituximab (375 mg/m2× 4); this data was analyzed retrospectively. Subsequently, 16 patients were prospectively randomized to receive rituximab with cyclophosphamide, vincristine and prednisone (R-CVP) or double dose rituximab (DDR). Retreatment with standard dose rituximab demonstrated responses similar to initial rituximab treatment in 15 of 20 patients. Neither of the two more intensive regimens (R-CVP, DDR) induced responses in any patient who had previously failed to respond to rituximab nor induced substantially longer-lasting responses among previous responders. No additional toxicity was noted with the DDR regimen, whereas R-CVP was not well tolerated. These results suggest that retreatment with standard dose rituximab induces similar responses in 75% of previously responding patients and is well tolerated. Neither combining rituximab with CVP nor doubling the dose of rituximab increased the response rate. Am. J. Hematol., 2009. © 2009 Wiley-Liss, Inc.

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