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Blood, 15 September 2002, Vol. 100, No. 6, pp. 2260-2262
BRIEF REPORT
Rituximab treatment of refractory fludarabine-associated immune
thrombocytopenia in chronic lymphocytic leukemia
Upendra P. Hegde,
Wyndham
H. Wilson,
Therese White, and
Bruce D. Cheson
From the Center for Cancer Research, National Cancer
Institute, National Institutes of Health, Bethesda, MD.
Fludarabine can exacerbate idiopathic thrombocytopenia (ITP) in
chronic lymphocytic leukemia (CLL). We report 3 CLL patients with
refractory fludarabine-associated ITP who responded to rituximab. The
patients had Rai stages III, III, and IV disease. Before
fludarabine treatment, the platelet counts were 141 000/µL,
118 000/µL, and 70 000/µL. ITP developed within week 1 of cycle 3 in 2 patients and within week 2 of cycle 1 in 1 patient. Platelet count
nadirs were 4000/µL, 1000/µL, and 2000/µL, respectively, and did
not respond to treatment with steroids or intravenous
immunoglobulin. Rituximab therapy (375 mg/m2 per week for 4 weeks) was begun on days 18, 23, and 20 of ITP. Patient 1 achieved a platelet count of more than 50 000/µL at day 21 and more
than 133 000/µL at day 28, patient 2 achieved a platelet count of
more than 50 000/µL at day 4 and more than 150 000/µL at day 10, and patient 3 achieved a platelet count of more than 50 000/µL at
day 5 and 72 000/µL at day 28 of rituximab therapy, with platelet
response durations of 17+, 6+, and 6 months. These results suggest
rituximab can rapidly reverse refractory fludarabine-associated ITP.
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