Publication

Abstract : Background Rituximab is a new agent used in patients with refractory chronic ITP. Rituximab has been conventionally administered in dose of 375 mg/m2 every seven days for four weeks.We ran a prospective clinical trial using lower dose rituximab in patients with chronic ITP who had not responded to at least one line of therapy & with platelet count below 30,000/mm3. Study has been approved by institute ethics committee. Patients & Methods Rituximab was given at the fi xed dose of 100 mg administered as an intravenous infusion weekly (on day 1 of weeks 1, 2, 3 and 4) to patients above 15 years, of chronic ITP who had not responded to at least one line of therapy. All cases of secondary ITP and pregnant patients were excluded from the study. A complete response (CR) was defi ned as a platelet count >100,000/mm3 and discontinuation of the steroid therapy. Partial response (PR) was defi ned as a platelet counts between 50 and 100,000/ mm3 and discontinuation of the steroid therapy. Results 15 patients have so far been given low dose rituximab as per protocol. Ten patients have completed at least 03 months of follow-up and are available for evaluation. Out of these 10 patients, 02 patients are post splenectomy relapse. Overall low dose rituximab was tolerated well in all patients with only infusion related adverse events noted. CR was achieved in 4/10 (40%) while 02 patients achieved PR giving an overall response of 6/10 (60%). Median time for response in these patients was 75 days (range 30 to 240 days). Median time of follow-up in 04 patients who did not respond was 94 days (range 91 to 133 days). Conclusions In patients of chronic ITP, lower dose rituximab is safe and effective and seems to show similar activity to standard dose. However longer follow-up is required to assess the durability of response to low dose of rituximab.