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Prepublished online as a Blood First Edition Paper on January 30, 2003; DOI 10.1182/blood-2002-09-2856.
Submitted September 19, 2002
Accepted January 25, 2003
Efficacy and safety of rituximab in type II mixed cryoglobulinemia
Francesco Zaja, Salvatore De Vita*, Cesare Mazzaro, Stefania Sacco, Daniela Damiani, Ginevra De Marchi, Angela Michelutti, Michele Baccarani, Renato Fanin, and Gianfranco Ferraccioli
Division of Rheumatology - DPMSC, University of Udine, Udine, Italy
Division of Hematology, University of Udine, Udine, Italy
Department of Medicine, Hospital of Pordenone, Pordenone, Italy
Institute of Hematology and Medical Oncology, L. A. Seragnoli, University of Bologna, Bologna, Italy
* Corresponding author; email: salvatore.devita{at}med.uniud.it.
The best treatment of type II mixed cryoglobulinemia (MC) has still to be defined. Antiviral treatment for the frequent underlying infectious trigger hepatitis C virus (HCV) may be ineffective, contraindicated or not tolerated in a fraction of cases, while current immunosuppressive treatments may lead to relevant complications. Selective B-cell blockade with rituximab was used in this study, based on favorable results in preliminary experience. Fifteen consecutive patients with type II MC (HCV-related in 12/15) were treated with rituximab, 375 mg/m2 I.V. weekly for 4 weeks. Only medium to low-dose steroids were allowed, if already administered at the time of recruitment. All the patients had active disease, poorly controlled or difficult to manage with previous treatments, including corticosteroids in all. Efficacy and safety of rituximab therapy was evaluated in the following 6 months. The overall follow-up after rituximab treatment ranged from 9 to 31 months. Rituximab proved effective on skin vasculitis manifestations (ulcers, purpura or urticaria), subjective symptoms of peripheral neuropathy, low-grade B-cell lymphoma, arthralgias, and fever. Nephritis of recent onset went into remission in one case. Laboratory features, i.e., significantly decreased serum rheumatoid factor and cryoglobulins, and increased C4, were consistent with the clinical efficacy. Treatment was well tolerated, with no infectious complications. Thrombosis of retinal artery or self-limiting panniculitis occurred in one patient each.
Rituximab may represent a safe and effective alternative to standard immunosuppression in type II MC. Controlled studies are needed to better define drug indications and the cost-efficacy profile in the different systemic manifestations.
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|
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|
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|
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67(3):
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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September 1, 2007;
46(9):
1389 - 1396.
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[Full Text]
[PDF]
|
|
|
|
|
|
|
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Hepatitis C-associated mixed cryoglobulinaemia: a crossroad between autoimmunity and lymphoproliferation
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46(8):
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|
|
|
|
|
|
|
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46(4):
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|
|
|
|
|
|
|
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66(3):
351 - 357.
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|
|
|
|
|
|
|
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Haematopoietic stem cell transplantation for vasculitis including Behcet's disease and polychondritis: a retrospective analysis of patients recorded in the European Bone Marrow Transplantation and European League Against Rheumatism databases and a review of the literature
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February 1, 2007;
66(2):
202 - 207.
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[Full Text]
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|
|
|
|
|
|
|
L. Chung, A. A. Funke, E. F. Chakravarty, J. P. Callen, and D. F. Fiorentino
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November 1, 2006;
142(11):
1407 - 1410.
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|
|
|
|
|
|
|
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Long-term observation of patients with anti-neutrophil cytoplasmic antibody-associated vasculitis treated with rituximab
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45(11):
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|
|
|
|
|
|
|
G. Merlini and M. J. Stone
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108(8):
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|
|
|
|
|
|
|
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Distinctive natural history in hepatitis C virus positive diffuse large B-cell lymphoma: analysis of 156 patients from northern Italy
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17(9):
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|
|
|
|
|
|
|
O. Bestard, J. M. Cruzado, G. Ercilla, M. Goma, J. Torras, D. Seron, I. Rama, M. Ibernon, O. Vinas, M. Carrera, et al.
Rituximab induces regression of hepatitis C virus-related membranoproliferative glomerulonephritis in a renal allograft
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August 1, 2006;
21(8):
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|
|
|
|
|
|
|
M Voulgarelis, S Giannouli, A G Tzioufas, and H M Moutsopoulos
Long term remission of Sjogren's syndrome associated aggressive B cell non-Hodgkin's lymphomas following combined B cell depletion therapy and CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)
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August 1, 2006;
65(8):
1033 - 1037.
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[Full Text]
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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45(6):
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|
|
|
|
|
|
|
S. De Vita and L. Quartuccio
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45(6):
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|
|
|
|
|
|
|
J. Kay and R. T. McCluskey
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353(15):
1605 - 1613.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Dimopoulos, R. A. Kyle, A. Anagnostopoulos, and S. P. Treon
Diagnosis and Management of Waldenstrom's Macroglobulinemia
J. Clin. Oncol.,
March 1, 2005;
23(7):
1564 - 1577.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S A Chambers and D Isenberg
Anti-B cell therapy (Rituximab) in the treatment of autoimmune diseases
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March 1, 2005;
14(3):
210 - 214.
[Abstract]
[PDF]
|
|
|
|
|
|
|
M. Catuogno, S. Rezai, R. Priori, L. Magrini, and G. Valesini
Serum sickness associated with rituximab in a patient with hepatitis C virus-related mixed cryoglobulinaemia
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March 1, 2005;
44(3):
406 - 406.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Nehme-Schuster, A.-S. Korganow, J.-L. Pasquali, and T. Martin
Rituximab inefficiency during type I cryoglobulinaemia
Rheumatology,
March 1, 2005;
44(3):
410 - 411.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Koukoulaki, S. C. Abeygunasekara, K. G. C. Smith, and D. R. W. Jayne
Remission of refractory hepatitis C-negative cryoglobulinaemic vasculitis after rituximab and infliximab
Nephrol. Dial. Transplant.,
January 1, 2005;
20(1):
213 - 216.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Ramos-Casals, A. Lopez-Guillermo, P. Brito-Zeron, R. Cervera, J. Font, and SS-HCV Study Group
Letter to the Editor
Lupus,
December 1, 2004;
13(12):
969 - 971.
[PDF]
|
|
|
|
|
|
|
D. Roccatello, S. Baldovino, D. Rossi, M. Mansouri, C. Naretto, M. Gennaro, R. Cavallo, M. Alpa, P. Costanzo, O. Giachino, et al.
Long-term effects of anti-CD20 monoclonal antibody treatment of cryoglobulinaemic glomerulonephritis
Nephrol. Dial. Transplant.,
December 1, 2004;
19(12):
3054 - 3061.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Voulgarelis, S. Giannouli, D. Anagnostou, and A. G. Tzioufas
Combined therapy with rituximab plus cyclophosphamide/doxorubicin/vincristine/prednisone (CHOP) for Sjogren's syndrome-associated B-cell aggressive non-Hodgkin's lymphomas
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August 1, 2004;
43(8):
1050 - 1053.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Stasi, M. Brunetti, E. Stipa, and S. Amadori
Selective B-cell depletion with rituximab for the treatment of patients with acquired hemophilia
Blood,
June 15, 2004;
103(12):
4424 - 4428.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M.-O. Chandesris, S. Gayet, N. Schleinitz, B. Doudier, J.-R. Harle, and G. Kaplanski
Infliximab in the treatment of refractory vasculitis secondary to hepatitis C-associated mixed cryoglobulinaemia
Rheumatology,
April 1, 2004;
43(4):
532 - 533.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T Shaw, J Quan, and M C Totoritis
B cell therapy for rheumatoid arthritis: the rituximab (anti-CD20) experience
Ann Rheum Dis,
November 1, 2003;
62(90002):
ii55 - 59.
[Full Text]
[PDF]
|
|
|
|
|
