The use of anti-CD20 in management of Egyptian children with chronic immune thrombocytopenic purpura

Background/aim Chronic immune thrombocytopenic purpura (ITP) is an immune-mediated platelet destruction, with decreased platelet count to less than 100×109/l for more than 12 months. Overall, 5-10% of children with chronic ITP experience serious bleeding, and their treatment is challenging. Rituximab is one of treatment options. Our aim is to evaluate low-dose rituximab in the management of childhood chronic ITP. Patients and methods Twenty-eight children with primary chronic ITP were prospectively administered rituximab at a dose of 100 mg/week for 4 weeks and followed up for 1 year. Results The initial response showed that 12/28 (42.8%) achieved complete remission, 2/28 (7%) minimal remission and 14/28 (50%) no remission. No significant differences were detected between responders and nonresponders regarding age and sex (P=0.94 and 0.59, respectively), except that the duration of the disease was significantly longer among nonresponders (P=0.025). The outcome after 1-year follow-up was as follows: one patient lost to follow-up, 14/28 (50%) were nonresponders, 8/28 (28%) relapsed, and 6/28 (21%) maintain sustained remission. Conclusion Rituximab is one of treatment choices for chronic ITP in children with convincing initial results; however, failure to achieve sustained remission is still a problem.