For patients with immune destruction of platelets, rituximabpromotes long-term response

A new analysis concludes that rituximab, a drug commonly used totreat blood cancers , leads to treatment responses lasting at least five years inapproximately one quarter of patients with low platelet counts anda risk of bleeding due to chronic immune thrombocytopenic purpura(ITP). In study results published online in Blood , the Journal of the American Society of Hematology (ASH),investigators at Weill Cornell Medical College provide the veryfirst long-term outcome data for patients with chronic ITP treatedwith rituxamab. Approximately 200,000 Americans suffer from ITP, a bleedingdisorder in which the immune system destroys blood cells calledplatelets that are necessary for normal blood clotting, which canresult in excessive bleeding and heavy bruising.1 Common treatmentoptions for increasing platelet counts in the majority of patientswith ITP include corticosteroid drug therapy, used to suppress apatient’s immune system in order to help bring platelet counts backto normal; splenectomy, the surgical removal of the spleen, to haltthe destruction of antibody-coated platelets found in the organ;and newer thrombopoietin (TPO)-mimetic agents to help stimulateplatelet production. While these treatments are successful in manypatients, all are associated with side effects: corticosteroids areassociated with bone loss, cataracts , and other serious toxicity with long-term use; splenectomy canincrease a patient’s risk of infection; and TPO-mimetic agents canresult in blood clots, and their long-term response in patients isnot well-studied. In addition to their reported side effects, somepatients with ITP stop responding or have insufficient response tothese therapies. IPL Laser Machine

More than ten years ago, researchers identified rituximab as analternative treatment for patients with chronic ITP who have failedat least one other therapy. Rituximab specifically destroys B-cells- the cells responsible for producing antibodies that coatplatelets and lead to their destruction – with low toxicity anddecreased risk of infection compared to other treatments. Previousstudies have shown that rituximab treatment resulted in normalizedplatelet counts lasting longer than one year in some patients withchronic ITP. Despite these encouraging reports, long-term data werepreviously lacking, and the durability and long-term safety of thistreatment were largely unknown. “While rituximab therapy for chronic ITP has been an excitingdevelopment, until now, due to a lack of sufficient patient numbersand follow-up in previous studies, we have only known how thistreatment will affect ITP patients in the short term,” said VivekL. China IPL Beauty Machine

Patel, PhD, the study’s first author and Research Associate atWeill Cornell Medical College in New York. “By utilizing thelongest follow-up and the largest number of responders to the drug,our study sought to determine how children and adults with chronicITP treated with rituximab would fare three, four, and five yearsdown the road.” In this follow-up study, Dr. Patel’s team reviewed 18 publishedclinical trials assessing rituximab treatment in children andadults with ITP and calculated initial and one-year response ratesfor 138 patients treated in 2000-2007 from seven clinical centersin the United States and Europe. Seventy-two adults with ongoingresponse one year from first treatment and 66 children with partialor complete response of any duration were included in the long-termanalysis. The investigators calculated five-year response rates of26 percent for children and 21 percent for adults. Erbium Laser Machine

The researchersalso analyzed the relationship of other clinical variables inresponse to rituximab and found no difference in projectedfive-year outcomes in children and adults who had undergone priorsplenectomy versus those who had not. Age, gender, prior ITPduration, and response to other ITP treatment were also notpredictive of duration of response. Results are particularly encouraging for ITP patients and theirphysicians who now have more substantial long-term data to helpthem decide whether and when to treat with rituximab. “The resultsfrom this study provide clinicians and patients with accurate andrealistic expectations of the long-term effect of rituximab and itspotential to become a first-line treatment for ITP,” said James B.Bussel, MD, senior author and Professor of Pediatrics at WeillCornell Medical College.

“Our next step is to try to augment theeffect of rituximab by combining it with dexamethasone, a commonsteroid therapy for ITP, in order to determine its effect inconjunction with known treatment strategies.” Additional References Citations.

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