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Anti-CD20 Chimeric Monoclonal Antibody Treatment of Refractory Immune-Mediated Thrombocytopenia in a Patient with Chronic Graft-versus-Host Disease

Voravit Ratanatharathorn, MD; Erik Carson, MD; Christopher Reynolds, MD; Lois J. Ayash, MD; John Levine, MD; Gregory Yanik, MD; Samuel M. Silver, MD, PhD; James L.M. Ferrara, MD; and Joseph P. Uberti, MD, PhD
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Copyright ©2004 by the American College of Physicians


Ann Intern Med. 2000;133(4):275-279. doi:10.7326/0003-4819-133-4-200008150-00011
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Background: Autoimmune thrombocytopenia in chronic graft-versus-host disease may represent an instance of B-cell dysregulation leading to clinical disease.

Objective: To attempt to treat refractory immune-mediated thrombocytopenia in a patient with chronic graft-versus-host disease by using anti-CD20 chimeric monoclonal antibody.

Design: Case report.

Setting: Academic medical center.

Patient: A patient with chronic graft-versus-host disease after allogeneic peripheral blood stem-cell transplantation who had severe refractory immune-mediated thrombocytopenia.

Intervention: Weekly infusion of rituximab, 375 mg/m2, for 4 weeks.

Measurements: Platelet count, CD3+ cell count, and CD19+ cell count.

Results: Rituximab therapy resulted in marked depletion of B cells in the peripheral blood and decreased levels of platelet-associated antibody. The increase in platelet count persisted despite tapering and discontinuation of immunosuppressive therapy for chronic graft-versus-host disease.

Conclusion: The efficacy of rituximab for the treatment of immune-mediated thrombocytopenia suggests that this drug may have activity in other autoimmune diseases or chronic graft-versus-host disease.

Figures

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Figure.
Clinical course of a patient with chronic graft-versus-host disease in whom severe refractory immune-mediated thrombocytopenia responded to treatment with anti-CD20 monoclonal antibody.

Anti-CD20 = rituximab; Anti-D = anti-D antibody; CY = cyclophosphamide; IVIG = intravenous immunoglobulins; MP = methylprednisolone; Spln = splenectomy; VCR = vincristine.

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