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Vol. 6. Issue 2.
Pages 82-85 (March - April 2010)
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Vol. 6. Issue 2.
Pages 82-85 (March - April 2010)
Original article
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Treatment with rituximab for thrombocytopenia due to systemic lupus erythematosus
Tratamiento con rituximab para la trombocitopenia secundaria a lupus eritematoso sistémico
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Rosa Elena Calderón Saldierna
Corresponding author
edra.rosa.calderon@hotmail.com

Corresponding author.
, María Azucena Ramos Sánchez, Yadhira Mejía Holguín, Laura Elena Aranda Baca, María Josefina Sauza del Pozo, Ariana Maia Becerra Márquez
Unidad Médica de Alta Especialidad N.° 25 del IMSS, Monterrey, Mexico
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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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References
[1]
A. Rahman, D. Isenberg.
Systemic Lupus Erythematosus Mechanisms of disease.
N Engl J Med, 358 (2008), pp. 929-939
[2]
R. Cervera, M.A. Khamashta, J. Font, G.D. Sebastiani, A. Gil, P. Lavilla, et al.
European Working Party on Systemic lupus erythematosus.Morbidity and Mortality in Systemic Lupus Erythematosus during a 10-Year period. A comparision of Early and Late Manifestations in a Cohort of 1,000 patients.
[3]
E.M. Tan, A.S. Cohen, J.F. Fries, A.T. Masi, D.J. McShane, N.F. Rothfield, et al.
The 1982 revised criteria for the classification of systemic lupus erythematosus.
Arthritis Rheum, 25 (1982), pp. 1271-1277
[4]
K. Moss, Y. Ioannou, S.M. Sultan, I. Haq, D.A. Isenberg.
Outcome of a cohort of 300 patients with systemic lupus erythematosus attending a dedicated clinic for over two decades.
Ann Rheum Dis, 61 (2002), pp. 409-413
[5]
M.M. Ward, E. Pyun, S. Studenski.
Mortality risks associated with specific clinical manifestations of systemic lupus erythematosus.
Arch Intern Med, 156 (1996), pp. 1337-1344
[6]
B. Roach, G. Hutchinson.
Treatment of refractory systemic lupus erythematosusassociated thrombocytopenia with intermittent low-dose intravenous cyclophosphamide.
Arthritis Rheum, 36 (1993), pp. 682-684
[7]
B. Godeau, E. Oksenhendler, P. Bierling.
Dapsone for autoimmune thrombocytopenic purpura.
Am J Hematology, 44 (1993), pp. 70-72
[8]
H. Cervera, L.J. Jara, S. Pizarro, H.L. Enkerlin, M. Fernandez, F. Medina, et al.
Danazol for systemic lupus erythematosus with refractory autoimmune thrombocytopenia or Evans’ Syndrome.
J Rheumatol, 22 (1995), pp. 1867-1871
[9]
D. Calverley, G. Jones, J. Kelton.
Splenic radiation for corticosteroid-resistant immune thrombocytopenia.
Ann Intern Med, 116 (1992), pp. 977-981
[10]
G. Silverman, S. Weisman.
Rituximab therapy and Autoimmune Disorders.
Arthritis Rheum, 48 (2003), pp. 1484-1492
[11]
C. Gorman, M. Leandro, D. Isenberg.
Does B cell depletion have a role to play in the treatment of systemic lupus erythematosus?.
Lupus, 13 (2004), pp. 312-316
[12]
E. Mantadakis, V. Danilatou, Stiakaki, M. Kalmati.
Rituximab for refractory Evans Syndrome and other immune-mediated hematologic diseases.
Am J Hematol, 77 (2004), pp. 303-310
[13]
N. Ahrens, G. Heymann, O. Meyer, H. Kiesewetter, A. Salama.
Results of treatment with rituximab in three patients with autoimmune hemolytic anemia and or immune thrombocytopenia and a concise review of reported cases.
Infusionsther Transfusions Med, 29 (2002), pp. 277-281
[14]
J.C. Edwards, G. Cambridge.
Sustained improvement in rheumatoid arthritis following a protocol designed to deplete B lymphocytes.
Rheumatology, 40 (2001), pp. 205-211
[15]
R.J. Looney, J. Anolik, I. Sanz.
Treatment of SLE with Anti-CD20 Monoclonal Antibody.
Curr Dir Autoimmun, 8 (2005), pp. 193-205
[16]
G.P. Fra, G.C. Avanzi, E. Bartoli.
Remission of refractory lupus nephritis whit a protocol including rituximab.
Lupus, 12 (2003), pp. 783-787
[17]
J. Garcia-Chavez, A. Majluf-Cruz, L. Montiel-Cervantes, M.G. Esparza, J. Vela-Ojeda, Mexican Hematology Study Group.
Rituximab therapy for chronic and refractory immune thrombocytopenic purpura: a long-term follow up analysis.
Ann Hematol, 86 (2007), pp. 871-877
[18]
F.J. Garcia-Hernandez, C. Díaz-Cobos, J.L. Callejas-Rubio, C. Ocaña-Medina, N. Ortego- Centeno, J. Sánchez-Román, et al.
Experiencia con rituximab en el tratamiento de pacientes con lupus eritematoso sistémico.
Reumatol Clin, 2 (2006), pp. 23-30
[19]
M.J. Leandro, J.C. Edwards, G. Cambridge, M.R. Ehrenstein, D.A. Isenberg.
An open study of B lymphocyte depletion in systemic lupus erythematosus.
Arthritis Rheum, 46 (2002), pp. 2673-2677
[20]
P. Braendstrup, O.W. Bjerrum, O.J. Nielsen, B.A. Jensen, N.T. Clausen, P.B. Hansen, et al.
Rituximab chimeric anti-CD 20 monoclonal antibody treatment for adult refractory idiopathic thrombocytopenic purpura.
Am J Hematol, 78 (2005), pp. 275-280
[21]
N. Cooper, R. Stasi, S. Cunningham-Rundles, M. Feuerstein, J. Leonard, S. Amadori, 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, 125 (2004), pp. 232-239
[22]
M.J. Leandro, G. Cambridge, J.C. Edwards, J. Edwards, M.R. Ehrenstein, D.A. Isenberg.
B cell depletion in the treatment of patients with systemic lupus erythematosus: a longitudinal analysis of 24 patients.
Rheumatology, 44 (2005), pp. 1542-1545
[23]
J.Z. Gillis, M. Dall’era, A. Gross, J. Yazdany, J. Davis.
Six refractory lupus patients treated with rituximab: a case series.
Arthritis Rheum, 57 (2007), pp. 538-542
[24]
R.J. Looney, J.H. Anolik, D. Campbell, R.E. Felgar, F. Young, L.J. Arend, et al.
B Cell depletion as a novel treatment for systemic lupus erytrematosus.
Arthritis Rheum, 50 (2004), pp. 2580-2589
Copyright © 2010. Sociedad Española de Reumatología and Colegio Mexicano de Reumatología
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