Should rituximab be used before or after splenectomy in patients with immune thrombocytopenic purpura?
PURPOSE OF REVIEW: The anti-CD20 monoclonal antibody rituximab has been used to treat patients with chronic immune thrombocytopenic purpura. This review discusses whether the optimal timing for this therapy is before splenectomy, or after failure of splenectomy. RECENT FINDINGS: No study has directly compared rituximab to splenectomy in patients with chronic immune thrombocytopenic purpura. Rituximab produces an initial response in approximately 60% of cases, with no significant difference between splenectomized and nonsplenectomized patients. Long-term complete responses are observed in 15-20% of cases. Adverse events related to the drug were usually mild or moderate, with a low incidence of infections. Long-term safety data, however, are still lacking. Deaths have been reported for 2.9% of immune thrombocytopenic purpura cases treated with rituximab, but they could not be attributed to the study drug. SUMMARY: Both the response rate and the response duration appear lower following ri
Related Questions
- My ITP patients have had good responses to rituximab when used as a second- or third- line therapy. Are there data to support using rituximab as a first line treatment of ITP?
- Are the favorable outcomes of splenectomy predictable inpatients with idiopathic thrombocytopenic purpura (ITP)?
- Should rituximab be used before or after splenectomy in patients with immune thrombocytopenic purpura?
