Introducción: la púrpura trombocitopénica inmune se caracteriza por trastornos hemorrágicos asociados con conteo disminuido de plaquetas debido a autoanticuerpos antiplaquetarios. El objetivo de la presente investigación fue evaluar la utilidad del rituximab para tratar la púrpura trombocitopénica inmune refractaria.
Casos clínicos: cuatro mujeres con púrpura trombocitopénica inmune sin respuesta al tratamiento estándar, en quienes en diferentes momentos se evaluó la respuesta clínica y la cantidad total de plaquetas. Las cuatro pacientes presentaron petequias, en dos acompañadas de equimosis, en una de hematemesis y en otra de sangrado transvaginal; el conteo basal promedio de plaquetas fue de 5350/µL; en el día 60 posterior a la primera dosis de rituximab, la cantidad promedio fue de 175 250/µL. Se consideró remisión completa en tres pacientes.
Conclusiones: si bien el rituximab es una opción para el tratamiento de la púrpura trombocitopénica inmune en los sujetos con falla al tratamiento convencional, se requieren más estudios.
Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med 2002:346(13):995-1008.
George JN, Woolf SH, Raskob GE, Wasser JS, Aledort LM, Ballem PJ, et al. Idiopathic thrombocytopenic purpura. Blood 1996:88(1):3-40.
Cines D, Bussel J. How I treat idiopathic thrombocytopenic purpura (ITP). Blood 2005;106(7): 2244-2251. Disponible en http://bloodjournal. hematologylibrary.org/content/106/7/2244. long
Godeau B, Provan D, Bussel J. Immune thrombocytopenic purpura in adults. Curr Opin Hematol 2007;14(5):535-556.
Godeau B, Chevret S, Varet B, Lefrère F, Zini JM, Bassom-pierre F, et al. French ATIP Study Group. Intravenous immunoglobulin or high-dose methylprednisolone, with or without oral prednisone for adults with untreated severe autoimmune thrombocytopenic purpura: a randomised, multicentre trial. Lancet 2002;359(9300):23-29.
Scaradavou A, Woo B, Woloski BM, Cunningham-Rundles S, Ettinger LJ, Aledort LM, et al. Intravenous anti-D treatment of thrombocytopenic purpura: experience in 272 patients. Blood 1997;89(8):2689-2700. Disponible en http://bloodjournal.hematologylibrary.org/content/89/8/2689. long
Kojouri K, Vesely SK, Terrell DR, George JN. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood 2004;104(9):2623-2634. Disponible en http://bloodjournal.hematologylibrary.org/content/104/9/2623.long
Vesely SK, Perdue JJ, Rizvi MA, Terrell DR, George JN. Management of adult patients with persistent idiopathic thrombocytopenic purpura following splenectomy: a systematic review. Ann Intern Med 2004;140(2):112-120.
George JN, Woolf SH, Raskob GE, Wasser JS, Aledort LM, Ballem PJ, et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood 1996;88 (1):3-40. Disponible en http://bloodjournal. hematologylibrary.org/content/88/1/3.long
British Committee for Standards in Haematology General Haematology Task Force. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol 2003 120(4):574-596.
Rodeghiero F, Ruggieri M. Is splenectomy still the gold standard for the treatment of chronic ITP? Am J Hematol 2008;83(2):91.
Dolan JP, Sheppard BC, DeLoughery TG. Splenectomy for immune thrombocytopenic purpura: surgery for the 21st century. Am J Hematol 2008;83(2):93-96.
Johnson AE, Gordon C, Palmer RG, Bacon PA. The prevalence and incidence of systemic lupus erythematosus in Birmingham, England. Relationship to ethnicity and country of birth. Arthritis Rheum 1995;38(4):551–558.
Cines DB, McMillan R. Management of adult idiopathic thrombocytopenic purpura. Annu Rev Med 2005;56:425-442.
Pescovitz MD. Rituximab, an anti-cd20 monoclonal antibody: history and mechanism of action. Am J Transplant 2006;6(5 Pt 1):859-866.
El-Habbash MM, Alwindi AM. Progress in immunotherapy rituximab. Saudi Med J 2007;28(11):1635-1644.16.
Bello C, Sotomayor EM. Monoclonal antibodies for B-cell lymphomas: rituximab and beyond. Hematology Am Soc Hematol Educ Program 2007:233-242.
Cooper N, Bussel, J. The pathogenesis of immune throm-bocytopaenic purpura. Br J Haematol 2006;133(4):364-374.
Sukati H, Watson HG, Urbaniak SJ, Barker RN. Mapping helper T-cell epitopes on platelet membrane glycoprotein IIIa in chronic autoimmune thrombocytopenic purpura. Blood 2007;109(10):4528-4538. Disponible en http://bloodjournal. hematologylibrary.org/content/109/10/4528. full.pdf
Semple, JW. T cell and cytokine abnormalities in patients with autoimmune thrombocytopenic purpura. Transfus Apher Sci 2003;28(3):237-242.
Yu J, Heck S, Patel V, Levan J, Yu Y, Bussel JB, Yazdan-bakhsh K. Defective circulating CD25 regulatory T cells in patients with chronic immune thrombocytopenic purpura. Blood 2008;112(4):1325-1328. Disponible en http:// www. ncbi.nlm.nih.gov/pmc/articles/PMC2515134/?tool= pubmed
García-Chávez J, Majluf-Cruz A, Montiel-Cervantes L, García-Ruiz Esparza M,1 Vela-Ojeda J; Mexican Hematology Study Group. Rituximab therapy for chronic and refractory immune thrombocytopenic purpura: a long-term follow-up analysis. Ann Hematol 2007;86(12):871-877.
Arnold DM, Dentali F, Crowther MA, Meyer RM, Cook RJ, Sigouin C, et al. Systematic review: efficacy and safety of rituximab for adults with Idiopathic thrombocytopenic purpura. Ann Intern Med 2007;2;146(1):25-33.
Burzynski J. New options after first-line therapy for chronic immune thrombocytopenic purpura. Am J Health Syst Pharm 2009;15;66(2 Suppl 2):S11-21.