大剂量地塞米松联合小剂量利妥昔单抗作为二线方案治疗65例原发免疫性血小板减少症患者的临床观察

OBJECTIVE: To observe the efficacy of high-dose dexamethasone in combination with low-dose rituximab as a second-line treatment for patients with immune thrombocytopenia (ITP). METHODS: 65 patients with ITP, previously by conventional dose of glucocorticoids, received high-dose dexamethasone in combination with low-dose rituximab (dexamethasone 40 mg/d for 4 days, rituximab 100 mg, d 7, 14, 21, 28 intravenous infusion). Treatment response, regulatory T cells (Treg), cytokines levels and treatment-related adverse effects were observed. RESULTS: Total response rate 1 month after treatment was achieved in 81.5% (53/65) of patients, and complete response at 3,6 and 12 months was 72.3% (47/65), 66.2% (43/65), 63.1% (41/65). The higher efficiency and complete response rate was achieved in preexisting glucocorticoid-dependent patients. For patients with complete response, Treg cells continued to show a high level state [(3.01±0.95)% vs (1.69±0.35)%,P=0.032], cytokines of BAFF [(648.03±79.63) ng/L vs (972.35±93.64) ng/L,P=0.001], IL-2 [(2.84±0.32) ng/L vs (4.18±0.46) ng/L,P=0.012], sCD40L [(4.55±0.66) ng/L vs (7.73±1.04) ng/L,P=0.006] significantly lower than that before treatment. The level of IL-10 was increased, but without significance compared with that before treatment(P=0.136). All patients completed the protocol with no serious adverse reactions. CONCLUSION: The data show high-dose dexamethasone in combination with low-dose rituximab still has a satisfactory outcomes for patients previously with conventional dose of glucocorticoid.