Successful treatment of refractory idiopathic thrombocytopenic purpura and neutropenia with the monoclonal antibody, rituximab

We describe a 22-year-old male with idiopathic
autoimmune thrombocytopenia whose diagnosis was made
at age of eight. He underwent splenectomy at age ten and
ITP recurred at age 21 with episodes of infection and
severe neutropenia (absolute count around 170/ll). He
showed no response to immunoglobulin, corticosteroids,
danazol, cyclosporine and azathioprine. Anti-CD20 antibody
was administered at a dose of 375 mg/m2 once a
week for 2 weeks. After the second infusion of rituximab,
the platelet count increased from 4,000 to 516,000/mm3
and neutrophils count raised from 180 to 545/mm3. The
response improvement persisted during follow up for
9 months (neutrophil count 4,390/mm3). This observation
indicates that B-cells may play a central role in the pathogenesis
of ITN. Anti-CD20 antibody therapy may be an
efficient treatment for the patients with chronic or recurrent
ITN