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15 August 2000 | Volume 133 Issue 4 | Pages 275-279
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.
Author and Article Information
From Blood and Marrow Stem Cell Transplant Program, University of Michigan Medical Center, Ann Arbor, Michigan.
Acknowledgments: The authors thank D. Rummler, T. Hunt, J. Wegner, K. Jacobi, H. Hinds, S. Anderson, M. Glasser, T. Norton, B. Wilson, and L. Lamirand for their dedicated patient care and A. Perrotta for his astute clinical skill in the management of patients with thrombocytopenia.
Requests for Single Reprints: Voravit Ratanatharathorn, MD, B1-207 Cancer Center, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109; e-mail, vratanat{at}umich.edu.
Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.
Current Author Addresses: Drs. Ratanatharathorn, Carson, Reynolds, Ayash, Levine, Yanik, Silver, Ferrara, and Uberti: Blood and Marrow Stem Cell Transplant Program, Departments of Internal Medicine and Pediatrics, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109.
Author Contributions: Conception and design: V. Ratanatharathorn, S.M. Silver, J.P. Uberti.
Analysis and interpretation of the data: V. Ratanatharathorn, E. Carson, C. Reynolds, L.J. Ayash, J. Levine, G. Yanik, S.M. Silver, J.P. Uberti.
Drafting of the article: V. Ratanatharathorn, E. Carson, L.J. Ayash, J. Levine, G. Yanik, S.M. Silver, J.P. Uberti.
Critical revision of the article for important intellectual content: V. Ratanatharathorn, C. Reynolds, L.J. Ayash, J. Levine, G. Yanik, S.M. Silver, J.L.M. Ferrara, J.P. Uberti.
Final approval of the article: V. Ratanatharathorn, C. Reynolds, L.J. Ayash, S.M. Silver, J.P. Uberti.
Provision of study materials or patients: S.M. Silver, J.P. Uberti.
Administrative, technical, or logistic support: V. Ratanatharathorn, J.L.M. Ferrara, J.P. Uberti.
Collection and assembly of data: V. Ratanatharathorn, E. Carson, J.P. Uberti. BRIEF COMMUNICATION
Anti-CD20 Chimeric Monoclonal Antibody Treatment of Refractory Immune-Mediated Thrombocytopenia in a Patient with Chronic Graft-versus-Host Disease
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