Gender and duration of disease differentiate responses to rituximab-dexamethasone therapy in adults with immune thrombocytopenia AMERICAN JOURNAL OF HEMATOLOGY Chapin, J., Lee, C. S., Zhang, H., Zehnder, J. L., Bussel, J. B. 2016; 91 (9): 907–11

Abstract

Adults often develop chronic immune thrombocytopenia (ITP) for which treatment order is uncertain. Rituximab and three cycles of dexamethasone (4R?+?3Dex) improve treatment responses and short-term disease control but long-term outcome is not known. In adults with ITP treated with 4R?+?3D, we sought long-term outcome and associated prognostic variables. Forty-nine adults treated at Weill-Cornell received 4R?+?3Dex. Their clinical characteristics were reviewed. Duration was median time to treatment failure; Kaplan-Meier estimates were developed. Vbeta Tcell receptor (VBTCR) repertoire was obtained after treatment in 36 patients. Patients were adults with ITP 18-64 years old, median age 37. The 27 females were twice as likely to have an ongoing response to 4R?+?3Dex (44.1%) as males (19.6%; P?=?0.009). For ITP duration <12 months, 52.7% of patients had continuing responses to 4R?+?3Dex compared to 15.3% of patients with diagnosis >12 months (P?=?0.02). Females with ITP duration of <12 months had continuing responses in 78.6%, compared to males with <12 months duration of ITP (21.2%). For patients with disease duration <12 months, 67% of females had continuing responses, compared to 31% of males (P?=?0.004). Post-treatment polyclonal VBTCR was seen in 9/10 continuing responders (six female, three male) but only 13/26 relapsers/nonresponders (P?=?0.068). Durable remissions after treatment with 4R?+?3Dex were more frequent in female patients with <12 months of ITP duration and those with polyclonal VBTCR after treatment, emphasizing the roles of duration of disease, gender and T cells in chronic ITP. Differences in pathophysiology of ITP by gender and by duration of ITP require further study. Am. J. Hematol. 91:907-911, 2016. © 2016 Wiley Periodicals, Inc.

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