Chronic immune thrombocytopenic purpura – successful treatment with anti-CD 20 antibodies

Summary

Immune thrombocytopenic purpura is common bleeding disorder in children characterized by skin and mucous bleeding. There is an isolated thrombocytopenia caused by antithrombotic antibodies. The standard treatment is corticosteroids and intravenous immunoglobulins. The alternative treatment might be anti-CD 20 antibodies. Splenectomy should be considered when treatment mentioned above failed. In adult patients we can use also trombopoetin analogs as a novel approach in the therapy. We describe the case of five-year- old girl sent to our clinic with low platelet count and diffuse bruising. The intravenous immunoglobulins administered did not lead to sufficient response. Due to further decrease of thrombocytes count we commenced her on prednisone. As the initial dose of 1 mg/ kg/ day was not sufficient for clinical response, we doubled the dose. Remission was reached in two weeks after the dose change, however remained only for eight weeks. Thus we decided for alternate treatment with anti-CD 20 antibodies to prevent repeated frequent relapses. The platelet count increased progressively during this treatment and stayed stable until now. The prognosis in patients with chronic immune thrombocytopenic purpura is uncertain. The alternate treatment with anti-CD 20 antibodies might lead to the remission, prevent or at least postpone splenectomy and thus improve the quality of life.

Key words:
immune thrombocytopenia –  children –  prednisone –  intravenous immunoglobulins –  anti-CD 20 antibodies