Treatment with rituximab for thrombocytopenia due to systemic lupus erythematosus

Calderón Saldierna, Rosa Elena; Ramos Sánchez, María Azucena; Mejía Holguín, Yadhira; Aranda Baca, Laura Elena; Sauza del Pozo, María Josefina; Becerra Márquez, Ariana Maia

doi:10.1016/S2173-5743(10)70018-6

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Abstract

Some patients with thrombocytopenia due SLE fail to respond to conventional therapies. Rituximab has been reported to be an alternative for patient treatment.

Objective

To evaluate the response of thrombocytopenia due to Systemic Lupus Erythematosus to the use of Rituximab and patient relapse time at our hospital.

Patients and methods

We analyzed patients with SLE than received a 2 gram rituximab treatment for thrombocytopenia. We analyzed the rate of patients that achieved complete remission (CR), defined as a platelet count over 100 mil/mm3, partial remission (PR) described as platelets within 50–100 mil/mm3 and no response (NR) if platelets remained unchanged and the time the remission was sustained.

Results

Sixteen treatments were applied to 13 patients, aged 28±9 years of age and SLE mean duration time of 68±44 months with a mean platelet count of 38±29 mil. In 14 treatments (87%) remission was achieved after 5±2 weeks where 2 patients (12.5%) were non respondent. One of them died due to a massive hemorrhage. The mean response time without relapse was 15.6±6 months. Follow up of three patients was not possible and 3 other died due to infections.

Conclusions

Rituximab is an alternative for treatment of thrombocytopenia due to Systemic Lupus Erythematosus.

Keywords:

Rituximab

Anti CD20

Systemic lupus erythematosus

Thrombocytopenia

Resumen

En algunos casos la trombocitopenia secundaria a lupus eritematoso sistémico (LES) no responde al tratamiento convencional. En los últimos años se ha reportado que el rituximab es una alternativa para estos pacientes.

Objetivo

Evaluar la respuesta de la trombocitopenia (T) secundaria a LES con el uso de rituximab y determinar el tiempo que se mantiene el efecto libre de recaída.

Material y métodos

Se revisaron los expedientes de los pacientes con diagnóstico de LES con T que recibieron tratamiento con rituximab (2g) para conocer la proporción de pacientes que lograron remisión completa (RC): definida como una cuenta plaquetaria >100.000/mm3; remisión parcial (RP): cuenta plaquetaria entre 50.000 y 100.000/mm3 y los no respondedores (NR); así como el tiempo que se mantiene el paciente sin recaída.

Resultados

Se aplicaron 16 tratamientos en 13 pacientes, en una paciente 3 y en otra 2 ciclos. Fueron 12 mujeres y 1 hombre con edad media de 28±9 años y tiempo medio de duración del LES de 68±44 meses, con una cuenta media plaquetaria de 38.000±29.000. En 14 tratamientos (87%) se logró RC después de 5±2 semanas y 2 pacientes (12.5%) fueron NR. Una de ellas murió por hemorragia masiva. El tiempo medio de respuesta sin recaída fue de 15,6±6 meses. Tres pacientes perdieron el seguimiento y 3 murieron de infecciones.

Conclusiones

El rituximab es una alternativa de tratamiento en pacientes con T secundaria a LES.

Palabras clave:

Rituximab

Anti CD20

Lupus eritematoso sistémico

Trombocitopenia

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