Re-traitement par Rituximab au cours du purpura thrombopénique immunologique de l’adulte : étude rétrospective multicentrique de 50 cas

Abstract : Introduction: Immune thrombocytopenia (ITP) is the most common auto-immune cytopenia. Rituximab (RTX, anti-CD20 monoclonal antibody) is one of the second-line treatments, with an initial overall response rate in 60% of patients. However, most patients relapse after this treatment. In this context, data regarding retreatment with one or multiple course of rituximab are scarce. Patients and Methods: We performed a multicenter retrospective study, including adults ITP treated with two or more rituximab courses. Primary objective was to evaluate overall response rate after the second rituximab course. Secondary objectives were to identify predictive factors of response to a second course of rituximab and evaluate the safety of such a therapeutic strategy. Results: Fifty patients were analyzed. Forty-three patients (86%) had primary ITP. Median number of previous line of treatment was 3[2-4] before first rituximab course. Median age was 39 years [23.25-53.5] at ITP diagnostic and 46 years [30.25-58] at first rituximab course. After a second rituximab course, an overall response was observed in 70 % of cases, with 60% of complete response. Among responders to the first course (n=44), 34 patients (77%) were responders to the second course. Compared to the first course, the type of response was similar or better in 76% of cases. Among evaluable patients (n=40), duration of response was similar or longer in 60% of cases. Patients who did not respond to the first rituximab neither respond to a second course. In multivariate analysis, response to a second course of rituximab was significantly associated with response to the first rituximab course (OR: 14.158 (95% IC, 1.035-193.729) p=0.047). Infections were reported in 13 patients (36%) during follow-up, without any opportunistic infection. Conclusion: Among responders to a first rituximab course, rituximab retreatment appears as an effective and well tolerated therapeutic option in ITP patients.
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Matthieu Patient. Re-traitement par Rituximab au cours du purpura thrombopénique immunologique de l’adulte : étude rétrospective multicentrique de 50 cas. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02092568⟩

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