Successful treatment with rituximab of refractory immune thrombocytopenic purpura

Idiopathic thrombocytopenic purpura (ITP) is a disorder characterized by accelerated destruction of platelets. About 25 to 30% of patients with ITP are resistant to standard treatment. Recent reports suggest that rituximab may be useful in treating chronic refractory ITP. We report a case of a 72-year-old woman with ITP resistant to standard treatment with steroids (prednisone 2 mg/kg for 2 weeks, followed by prednisone 1 mg/kg) and intravenous immunoglobulin (0,5 mg/kg for 5 days). An infection by Helicobacter pylori was eradicated; afterwards she was treated with rituximab 375 mg/m2, once weekly for four weeks, resulting in a complete long-lasting response. Rituximab could represent a satisfactory alternative to the splenectomia in the adults with ITP; in our case the remission is complete (stable platelets > 200 x 109 after 8 months), early (before the fourth dose) and sustained (follow-up 18 months).