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Evolución clínica de 31 pacientes adultos con trombocitopenia inmune tratados con rituximab / Clinical evolution of 31 adult patients with immune thrombocytopenia treated with rituximab

Guillermo Rodolfo Gutiérrez-Espíndola, Jesús Medrano-Contreras, Dafne Itzel Campa-Monroy, Elizabeth Sabbagh-Sánchez, Raúl Martínez-Castro




Introducción: la trombocitopenia inmune primaria (TIP) es una enfermedad autoinmune que puede causar hemorragias de diferente intensidad, las cuales llegan a poner en peligro la vida y alteran la calidad de vida de los pacientes. Puede ser tratada con rituximab como primera o segunda línea y la respuesta global es de 60%. Los mejores resultados se han observado en mujeres jóvenes con tiempo breve de evolución.

Objetivo: reportar la respuesta y la evolución clínica con el tratamiento de rituximab usado como un rescate en pacientes adultos con TIP en fase crónica o persistente de la enfermedad.

Material y métodos: se le administró rituximab de forma semanal por cuatro dosis a 31 pacientes adultos y se les hizo seguimiento durante un año.

Resultados: de los 31 pacientes adultos, se observó respuesta completa (RC, plaquetas ≥ 100 x 109/L) en 22 pacientes (71%) y respuesta parcial (RP, plaquetas ≥ 30 y ≤ 99x 109/L) en 5 pacientes (16%); la respuesta global fue de 87%. Tres pacientes recayeron durante el seguimiento y la respuesta sostenida (≥ 12 meses) se mantuvo en 24 pacientes, 21 (67%) con RC y 3 (10%) con RP. Los efectos secundarios fueron de leves a moderados en 13% de los pacientes.

Conclusiones: el rituximab demostró su utilidad en pacientes con TIP como tratamiento de rescate en las fases crónica y persistente. La respuesta sostenida ≥ 12 meses fue de 77%, con buena tolerancia y toxicidad aceptable.



Background: Primary immune thrombocytopenia (ITP) is an autoimmune disease that could cause different grades of bleeding, which could even threat the patients’ life or make them experience poor quality of life. ITP can be treated with rituximab either as a first or second-line therapy option, resulting in an overall response of 60%. The best results have been observed on young women with a short time of disease evolution.

Objective: To report the response and clinical evolution by providing therapy with rituximab, which was used as a rescue in adult patients with either persistent or chronical ITP.

Material and methods: 4 weekly doses of rituximab were administered to 31 adult patients and it was made a followup with them for a year.

Results: Out of the 31 patients, a complete response was observed (CR, platelets ≥ 100 x 109/L) in 22 patients (71%), and a partial response (PR, platelets ≥ 30 and ≤ 99 x 109/L) in 5 patients (16%); the global response was of 87%. 3 patients relapsed during follow-up and sustained response after rituximab (≥ 12 months) was held in 24 patients, 21 (67%) with CR and 3 (10%) with PR. Side effects were from low to moderate in 13% of patients.

Conclusions: Rituximab showed its effectiveness in patients with ITP as a rescue therapy in both chronical and persistent phases. Sustained response ≥ 12 months was of 77%, with good tolerance and acceptable toxicity.

Palabras clave

Trombocitopenia Autoinmune; Rituximab / Immune Thrombocytopenia; Rituximab

Texto completo:



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