More about the combination of rituximab, cyclosporine and dexamethasone in the treatment of chronic ITP. A useful option on an environment with limited resources

References

• Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, Bussel JB, Cines DB, Chong BH, Cooper N, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 2009;113(11):2386–2393. doi:10.1182/blood-2008-07-162503
   PubMed Web of Science ®Google Scholar
• Nomura S. Advances in Diagnosis and Treatments for Immune Thrombocytopenia. Clin Med Insights Blood Disord 2016;9:15–22. doi:10.4137/CMBD.S39643
   PubMedGoogle Scholar
• McMillan R, Durette C. Long-term outcomes in adults with chronic ITP after splenectomy failure. Blood 2004;104(4):956–960. doi:10.1182/blood-2003-11-3908
   PubMed Web of Science ®Google Scholar
• Portielje JE, Westendorp RG, Kluin-Nelemans HC, Brand A. Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood 2001;97(9):2549–2554. doi:10.1182/blood.v97.9.2549
   PubMed Web of Science ®Google Scholar
• Berchtold P, McMillan R. Therapy of chronic idiopathic thrombocytopenic purpura in adults. Blood 1989;74(7):2309–2317.
   PubMed Web of Science ®Google Scholar
• McMillan R. Long-term outcomes after treatment for refractory immune thrombocytopenic purpura. N Engl J Med 2001;344(18):1402–1403. doi:10.1056/NEJM200105033441815
   PubMed Web of Science ®Google Scholar
• Patel VL, Mahevas M, Lee SY, Stasi R, Cunningham-Rundles S, Godeau B, Kanter J, Neufeld E, Taube T, Ramenghi U, et al. Outcomes 5 years after response to rituximab therapy in children and adults with immune thrombocytopenia. Blood 2012;119(25):5989–5995. doi:10.1182/blood-2011-11-393975
   PubMed Web of Science ®Google Scholar
• Apostolidis J, Tsandekidi M, Kousiafes D, Pagoni M, Mitsouli C, Karmiris T, Bakiri M, Karakasis D, Harhalakis N, Nikiforakis E. Short-course corticosteroid-induced pulmonary and apparent cerebral aspergillosis in a patient with idiopathic thrombocytopenic purpura. Blood 2001;98(9):2875–2877. doi:10.1182/blood.v98.9.2875a
   PubMed Web of Science ®Google Scholar
• Norgaard M, Jensen AO, Engebjerg MC, Farkas DK, Thomsen RW, Cha S, Zhao S, Sørensen HT. Long-term clinical outcomes of patients with primary chronic immune thrombocytopenia: a Danish population-based cohort study. Blood 2011;117(13):3514–3520. doi:10.1182/blood-2010-10-312819
   PubMed Web of Science ®Google Scholar
• Swinney RM, Hsu SC, Hirschman BA, Chen TT-C, Tomlinson GE. MDM2 promoter variation and age of diagnosis of acute lymphoblastic leukemia. Leukemia 2005;19(11):1996–1998. doi:10.1038/sj.leu.2403941
   PubMed Web of Science ®Google Scholar
• Dohner H, Stilgenbauer S, Benner A, Leupolt E, Kröber A, Bullinger L, Döhner K, Bentz M, Lichter P. Genomic aberrations and survival in chronic lymphocytic leukemia. N Engl J Med 2000;343(26):1910–1916. doi:10.1056/NEJM200012283432602
   PubMed Web of Science ®Google Scholar
• Vesely SK, Perdue JJ, Rizvi MA, Terrell DR, George JN. Management of adult patients with persistent idiopathic thrombocytopenic purpura following splenectomy: a systematic review. Ann Intern Med 2004;140(2):112–120. doi:10.7326/0003-4819-140-3-200402030-00012
   PubMed Web of Science ®Google Scholar
• Emilia G, Morselli M, Luppi M, Longo G, Marasca R, Gandini G, Ferrara L, D’Apollo N, Potenza L, Bertesi M, et al. Long-term salvage therapy with cyclosporin A in refractory idiopathic thrombocytopenic purpura. Blood 2002;99(4):1482–1485. doi:10.1182/blood.v99.4.1482
   PubMed Web of Science ®Google Scholar
• Kappers-Klunne MC, Van’t Veer MB. Cyclosporin A for the treatment of patients with chronic idiopathic thrombocytopenic purpura refractory to corticosteroids or splenectomy. Br J Haematol 2001;114(1):121–125. doi:10.1046/j.1365-2141.2001.02893.x
   PubMed Web of Science ®Google Scholar
• Zver S, Zupan IP, Cernelc P. Cyclosporin A as an immunosuppressive treatment modality for patients with refractory autoimmune thrombocytopenic purpura after splenectomy failure. Int J Hematol 2006;83(3):238–242. doi:10.1532/IJH97.05149
   PubMed Web of Science ®Google Scholar
• Hlusi A, Szotkowski T, Indrak K. Refractory immune thrombocytopenia. Successful treatment with repeated cyclosporine A: two case reports. Clin Case Rep 2015;3(6):337–341. doi:10.1002/ccr3.182
   PubMed Web of Science ®Google Scholar
• Gudbrandsdottir S, Birgens HS, Frederiksen H, Jensen BA, Jensen MK, Kjeldsen L, Klausen TW, Larsen H, Mourits-Andersen HT, Nielsen CH, et al. Rituximab and dexamethasone vs dexamethasone monotherapy in newly diagnosed patients with primary immune thrombocytopenia. Blood 2013;121(11):1976–1981. doi:10.1182/blood-2012-09-455691
   PubMed Web of Science ®Google Scholar
• Bussel JB, Lee CS, Seery C, Imahiyerobo AA, Thompson MV, Catellier D, Turenne IG, Patel VL, Basciano PA, Elstrom RL, et al. Rituximab and three dexamethasone cycles provide responses similar to splenectomy in women and those with immune thrombocytopenia of less than two years duration. Haematologica 2014;99(7):1264–1271. doi:10.3324/haematol.2013.103291
   PubMed Web of Science ®Google Scholar
• Zaja F, Baccarani M, Mazza P, Bocchia M, Gugliotta L, Zaccaria A, Vianelli N, Defina M, Tieghi A, Amadori S, et al. Dexamethasone plus rituximab yields higher sustained response rates than dexamethasone monotherapy in adults with primary immune thrombocytopenia. Blood 2010;115(14):2755–2762. doi:10.1182/blood-2009-07-229815
   PubMed Web of Science ®Google Scholar
• Choi PY, Roncolato F, Badoux X, Ramanathan S, Ho S-J, Chong BH. A novel triple therapy for ITP using high-dose dexamethasone, low-dose rituximab, and cyclosporine (TT4). Blood 2015;126(4):500–503. doi:10.1182/blood-2015-03-631937
   PubMed Web of Science ®Google Scholar
• A’Hern RP. Sample size tables for exact single-stage phase II designs. Stat Med 2001;20(6):859–866. doi:10.1002/sim.721
   PubMed Web of Science ®Google Scholar
• Depre F, Aboud N, Mayer B, Salama A, Colombo GI. Efficacy and tolerability of old and new drugs used in the treatment of immune thrombocytopenia: results from a long-term observation in clinical practice. PLoS One 2018;13(6):e0198184. doi:10.1371/journal.pone.0198184
   PubMed Web of Science ®Google Scholar
• Khellaf M, Eckert L, Poitrinal P, Francesconi C, Haddad A, Languille L, Bierling P, Michel M, França LR, Launois R. Costs of managing chronic Immune Thrombocytopenic Purpura (ITP) in adults: A retrospective analysis. Am Soc Hematol 2009; 114 (22): 4462.
   Google Scholar
• Wang J, Li Y, Wang C, Zhang Y, Gao C, Lang H, Chen X. Efficacy and Safety of the Combination Treatment of Rituximab and Dexamethasone for Adults with Primary Immune Thrombocytopenia (ITP): A Meta-Analysis. BioMed Research International. 2018; 2018:1316096.
   Google Scholar
• Oved JH, Lee CSY, Bussel JB. Treatment of children with persistent and chronic idiopathic thrombocytopenic purpura: 4 infusions of rituximab and three 4-day cycles of dexamethasone. J Pediatr 2017;191:225–231. doi:10.1016/j.jpeds.2017.08.036
   PubMed Web of Science ®Google Scholar
• Yan Z, Li Z, Zhang H, Chen C, Li D, Xing W, Li H, Chen W, Cheng H, Cao J, et al. [Efficacy of high-dose dexamethasone plus low-dose rituximab as a second-line treatment in 65 patients with primary immune thrombocytopenia]. Zhonghua Xue Ye Xue Za Zhi 2015;36(3):206–209. doi:10.3760/cma.j.issn.0253-2727.2015.03.007
   PubMedGoogle Scholar
• Zaja F, Vianelli N, Volpetti S, Battista ML, Defina M, Palmieri S, Bocchia M, Medeot M, De Luca S, Ferrara F, et al. Low-dose rituximab in adult patients with primary immune thrombocytopenia. Eur J Haematol 2010;85(4):329–334. doi:10.1111/j.1600-0609.2010.01486.x
   PubMed Web of Science ®Google Scholar
• Gomez-Almaguer D, Tarin-Arzaga L, Moreno-Jaime B, Jaime-Pérez JC, Ceballos-López AA, Ruiz-Argüelles GJ, Ruiz-Delgado GJ, Cantú-Rodríguez OG, Gutiérrez-Aguirre CH, Sánchez-Cárdenas M. High response rate to low-dose rituximab plus high-dose dexamethasone as frontline therapy in adult patients with primary immune thrombocytopenia. Eur J Haematol 2013;90(6):494–500. doi:10.1111/ejh.12102
   PubMed Web of Science ®Google Scholar