Efectiveness of Rituximab in the Treatment of Refractory Autoimmune Cytopenias in Adults

Demetrio Torres^1*, Erick Salcedo², Laura Díaz³, Miguel Fernández³, Esteban Arellano⁴, Mauricio Chandía⁵

¹Medical Doctor, Cancer Center “Nuestra Sra. de la Esperanza”, Pontificia Universidad Católica de Chile, Santiago, Chile
²Medical Physicist, Cancer Center “Nuestra Sra. de la Esperanza”, Pontificia Universidad Católica de Chile, Chile
³Medical degree, Universidad San Sebastián, Concepción, Chile
⁴Medical Doctor, Medical School, Universidad Católica del Maule, Talca, Chile. Internal Medicine Service, Regional Hospital of Talca, Chile
⁵4Medical Doctor, Faculty of Medicine, Universidad de Concepción. Guillermo Grant Benavente Hospital, Concepción, Chile

Demetrio Torres, Medical Doctor, Cancer Center “Nuestra Sra. de la Esperanza”, Pontificia Universidad Católica de Chile, Santiago, Chile.

Keywords: Autoimmune Cytopenias; Immunologic Thrombocytopenic Purpura; Autoimmune Hemolytic Anemia; Rituximab

Abstract

The term autoimmune cytopenias is applied to a heterogeneous group of diseases characterized by a decrease in the peripheral hematological counts of one or more cellular series, product of autoimmunity. Corticosteroids are used in the first-line treatment, while splectonomy and immunosuppressant are used in second-line non-responders. The use of rituximab has been considered in those cases of refractory to first-line treatment or in those who are not candidates for splenectomy.
We present a series of ten patients with refractory autoimmune cytopenias who received rituximab at the regional hospital in Talca, Chile; during the period of 2008-2011. Five patients with immunologic thrombocytopenic purpura were treated; four of them obtained complete response, and one obtained partial response. The median of maximum response time was six weeks, remaining in that category after six months of follow-up care. Four patients were treated with rituximab for autoimmune hemolytic anemia; three of them obtained partial response, while one was lost in follow-up care stage. One patient was diagnosed with Evans syndrome secondary to chronic lymphocytic leukaemia (CLL), achieving considerable increases in the counts of both series, with a sustained response after six months of follow-up care. There were no adverse effects related to the drug.

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