Low Dose Rituximab in Chronic ITP: Still an Option in Resource Limited Settings

  • Rajan Kapoor
  • Rajiv Kumar
  • M. MahapatraEmail author
  • H. P. Pati
  • Suman Kumar Pramanik
Original Article


The etiology of ITP remains unknown but its pathogenesis consists of loss of tolerance to platelet antigens. There is a complex dysregulation of the immune system involving both the B cells and the T cells. Splenectomy is the standard second line option in steroid refractory chronic ITP patients. However, costs of surgery and reluctance for surgery in severely thrombocytopenic patients on part of surgeons are major obstacles in resource limited settings. Rituximab has been used in both the standard doses of 375 mg/m2 and low doses of 100 mg/m2 with similar results. We studied the utility of low dose Rituximab (@100 mg/m2 weekly × 4 doses) in resource limited settings. Overall response, complete response (CR) and partial response (PR) rates were 47.6% (10/21), 33.3% (7/21) and 14.3% (3/21) respectively. Median time to response in patients achieving CR was 75 days (range 45–185 days) while in patients achieving PR it was 105 days (range 45–165 days). However, there was no significant difference between males and females achieving CR or PR. We also observed that patients who had earlier responded to any form of treatment were more likely to respond to Rituximab treatment. The cumulative relapse free survival (RFS) at 13 months was 78%. By giving lower dose, six times less than conventional dosing dose, we have been able to demonstrate cost effectiveness in our study population. We were able to administer all the doses in day care without any major adverse events leading to further cost savings on in-patient care.


Immune thrombocytopenic purpura Refractory Rituximab Low dose 


Compliance with Ethical Standards

Conflict of interest

Authors Dr. Rajan Kapoor, Dr. Rajiv Kumar, Prof. M. Mahapatra, Prof. Hara P. Pati and Dr. Suman Kumar Pramanik declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Indian Society of Haematology & Transfusion Medicine 2016

Authors and Affiliations

  • Rajan Kapoor
    • 1
  • Rajiv Kumar
    • 1
  • M. Mahapatra
    • 2
    Email author
  • H. P. Pati
    • 2
  • Suman Kumar Pramanik
    • 3
  1. 1.Medicine and Clinical HematologyArmy Hospital (R&R)New DelhiIndia
  2. 2.Department of HematologyAll India Institute of Medical SciencesNew DelhiIndia
  3. 3.Medicine and Clinical HematologyCommand Hospital (EC)KolkataIndia

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