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Annals of Hematology

, Volume 86, Issue 3, pp 191–197 | Cite as

Lack of clinical efficacy of rituximab in the treatment of autoimmune neutropenia and pure red cell aplasia: implications for their pathophysiology

  • M. Dungarwalla
  • J. C. W. Marsh
  • J. A. Tooze
  • G. Lucas
  • W. Ouwehand
  • R. Pettengell
  • C. E. Dearden
  • E. C. Gordon Smith
  • M. O. Elebute
Original Article

Abstract

We describe 11 patients with severe refractory autoimmune cytopenias treated with the anti-CD20 monoclonal antibody rituximab. Six patients had autoimmune neutropenia (AIN), two had pure red cell aplasia (PRCA), one had AIN and autoimmune haemolytic anaemia, one had AIN and immune thrombocytopaenia purpura (ITP) and one had PRCA and ITP. Rituximab was administered at a dose of 375 mg/m2 as an intravenous infusion weekly for 4 weeks. Six of eight patients with AIN and all three patients with PRCA did not respond. Two patients died: one with resistant AIN and autoimmune haemolytic anaemia died of pneumocytis pneumonia infection, and one with PRCA and ITP died of an acute exacerbation of bronchiectasis. Rituximab in AIN and PRCA appears to be less effective than Campath-1H when compared to historical data from our group. This supports the hypothesis that T cells may be important in the pathophysiology of AIN and PRCA.

Keywords

Rituximab Campath-1H Autoimmune neutropenia Pure red cell aplasia 

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • M. Dungarwalla
    • 1
  • J. C. W. Marsh
    • 1
    • 2
  • J. A. Tooze
    • 2
  • G. Lucas
    • 3
  • W. Ouwehand
    • 4
  • R. Pettengell
    • 1
    • 2
  • C. E. Dearden
    • 5
  • E. C. Gordon Smith
    • 1
  • M. O. Elebute
    • 1
  1. 1.Department of HaematologySt George’s HospitalLondonUK
  2. 2.Department of Cellular and Molecular MedicineSt George’s University of LondonLondonUK
  3. 3.International Blood Group Reference LaboratoryBristolUK
  4. 4.Division of Transfusion MedicineUniversity of Cambridge and National Blood ServiceCambridgeUK
  5. 5.The Royal Marsden HospitalLondonUK

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