Clinical Effect Of A Low Dose Of Rituximab In The Treatment Of Refractory Immune Thrombocytopenia

Clinical features of Immune thrombocytopenia is a common acquired bleeding disorders, thrombocytopenia and bone marrow Megakaryocyte is characterized by normal or increased, a lack of sources or secondary factors, the principle is the patients produce antiplatelet autoantibodies and immune-mediated destruction of platelets. Immune thrombocytopenia with conventional treatments include high doses of corticosteroids, intravenous immunoglobulin and Splenectomy, treatment effective rate is70-80%,if enough glucocorticoid and (or) patients with Splenectomy is not valid is called Refractory Immune thrombocytopenia. The problem is that the treatment of Refractory ITP has no unified approach, most treatment for treating empirically, need to seek new and more effective and economical treatment method. Mei Luo Hua (rituximab) is a new type of biological agent, is the kind of human and mouse chimeric anti-CD20monoclonal antibody, is a new drug for treatment of ITP. Standard rituximab monoclonal antibody to375mg/m2,1time per week, a total of4times, and get better treatment effect, but the treatments are expensive, patients are difficult to accept it, this study explored with small dose of Mei Luo Hua in the treatment of refractory ITP clinical effects.Objective:to study the small dose of rituximab in the treatment of refractory Immune thrombocytopenia (ITP) in the treatment of clinical efficacy and adverse reaction.Method:analysis of8patients in Fourth Central Hospital from June2010to June2013in patients with refractory ITP, we use Mei Luo Hua (rituximab)100mg joined into,100ml saline intravenously,1time per week, a total of4times. Monitoring Complete Blood Count(CBC)1times per week during the treatment, outpatient follow up monitoring Complete Blood Count(CBC) for once every2weeks after the treatment, total measuring blood for3months, observing its efficacy and document the adverse drug reactions.Results:8cases patients in the markedly2cases,after the treatment in sixth week platelet respectively liters to151X109/L、110X109/L； good effect3cases, after the treatment in sixth week platelet respectively liters to68X109/L、57×109/L、60X 109/L; progress1cases, after the treatment in sixth week platelet liters to27×109/L; invalid2cases, after the treatment in sixth week platelet respectively liters to14×109/L、10×109/L; treatment effective rate for62.5%(five/eighths),5cases (markedly+good effect) starting from the2nd week of medication a varying degree of blood platelet count increase, by the day14,1patient have effect, and the remaining4patients onset time is21-35days, the median response time of28days. None of the cases appeared liver and renal impairment, severe reactions such as rash, hematological malignant lesions,1cases of allergic reaction occurred,3patients with varying degrees of difference and gastrointestinal reactions such as nausea, vomiting, and symptomatic. All the patients are in remission after the therapy.Conclusion:Small doses of rituximab in the treatment of refractory ITP efficacy, adverse effects were small, and small doses so affordable, more accessible, easy on refractory ITP treatment offers a new choice.