Clinical Efficacy Of Rituximab In The Treatment Of Adult Immune Thrombocytopenia:A Single Center Data Analysis

Objective(s):Immune thrombocytopenia(ITP)is a benign autoimmune bleeding disease characterized by destruction of platelet and impaired platelet production.Its pathogenesis has not been completely clear and definite.The main points focus on imbalance of immune tolerance.According to its pathogenesis,the main methods for the treatment of ITP.Humoral immunity mediated by B lymphocytes is still the most classic pathogenesis of ITP.According to its pathogenesis,rituximab therapy has become the treatment of choice for autoimmune diseases with abnormal B cell function/number,such as primary ITP and connective tissue disease secondary to ITP.Because rituximab is expensive and patients in Yunnan have different understanding of the drug and affordability of the economy,this study performed a retrospective approach to analyze the use of rituximab in patients with ITP who were treated at the Second Affiliated Hospital of Kunming Medical University to summarize the treatment experience and provide a single center data analysis.The ITP secondary to connective tissue disease was included in the study,which increased the understanding of this part of the diseaseMethods:The clinical materials of patients who were admitted to the Department of Hematology the Second Affiliated Hospital of Kunming Medical University from January 2014 to July 2020 were collected through the hospital medical record digital comprehensive management information system.The all patients were treated with rituximab,and meet the inclusion criteria.The related data of patients who were treated again in the outpatient department and inpatient department after treatment were inquired,and the follow-up work after discharge was made by telephone and WeChat.The following data were collected:the platelet count in peripheral blood of patients at 7 days,14 days,1 month,3 months,6 months after treatment and at the last follow-up visit,the onset time of rituximab,maintenance time,recurrence,subsequent treatment with other drugs/surgeries,drug-related adverse effects.At least 6 months follow-up information were recorded,and evaluated the curative effect of patients after treatment,and performed statistical analysis.Results:A total of 30 patients were included in the follow-up study.29 patients received low-dose rituximab therapy(100mg/w × 4w,375mg/m2),and 1 patients received standard rituximab therapy.The standard dose regimen was received by a 32-year-old female who had a complete response as of the end of follow-up and efficacy was maintained for 22 months.For group low-dose rituximab therapy:There were 6 males and 23 females,with a ratio of 1:3.8.The age was 43.83±12.51 years.The median disease duration was 14(1～136)months.The median follow-up time was 26(6～79)months.On the 7th day after the first application of rituximab,8 cases(27.6%)and 7 cases(24.1%)achieved CR and PR respectively;on the 14th day,there were 9 cases(31.0%)and 6 cases(20.7%)respectively.reached CR and PR;in the first month,12 cases(41.4%)and 7 cases(24.1%)reached CR and PR respectively.The long-term OR rate in June was 51.7%.The 1-year long-term OR rate was 38.1%.The 2-year long-term OR rate was 18.75%.Among the 30 patients,1 had interstitial pneumonia and respiratory failure,1 had fever,sore throat and systemic rash,and none had severe liver and kidney dysfunction,nausea,vomiting,rash,hematological malignancies,severe infections,and other adverse reactions.The correlation between bleeding score and age,course of disease and platelet count before treatment was not statistically different(r=-0.16,p=0.933;r=0.083,p=0.669;r=-2.27,p=0.154).Sex,age,disease stage,course,hormone response,past treatment,combined treatment,bleeding score,pre-treatment white blood cells,pre-treatment hemoglobin,pre-treatment platelets and efficacy were not statistically significant.Conclusion(s):The results showed that rituximab is effective in the treatment of adult ITP,with mild adverse reactions,and no index can be used as a predictor of the efficacy of rituximab.Our department uses small dosage regimen(375mg/m2,1 times)to treat patients,which can reduce the number of patients hospitalized and save hospitalization expenses.