Advertisement
JOGC
Advanced searchSave search
CASE REPORT| Volume 32, ISSUE 12, P1167-1171, December 2010

Download started.

Ok

Rituximab for Management of Refractory Pregnancy-Associated Immune Thrombocytopenic Purpura

DOI:https://doi.org/10.1016/S1701-2163(16)34741-7
Rituximab for Management of Refractory Pregnancy-Associated Immune Thrombocytopenic Purpura
Previous ArticleLong-term Efficacy of Pelvic Floor Muscle Rehabilitation for Older Women With Urinary Incontinence
Next ArticleLaparoscopic Internal Iliac Artery Ligation for Postpartum Spontaneous Hemoperitoneum
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Background

      Rituximab is a novel therapy for immune thrombocytopenic purpura (ITP); however, information about its safety in pregnancy is limited. This case illustrates the successful use of rituximab to treat pregnancy-associated ITP.

      Case

      A 34-year-old woman presented with severe ITP at 23 weeks’ gestation. Standard treatment with corticosteroids, intravenous immune globulin, and splenectomy failed to raise the platelet count. Due to ongoing bleeding, rituximab was given in the 26th week of pregnancy. The platelet count rose to over 100 × 109/L after four weeks. The neonatal B-lymphocyte count normalized at four months after delivery. There were no neonatal complications of rituximab therapy.

      Conclusion

      Rituximab may be safe for use in treating pregnancy-associated ITP. This case highlights the need to investigate further the safety and efficacy of rituximab in pregnancy.

      Résumé

      Contexte

      Le rituximab est un traitement novateur contre le purpura thrombocytopénique auto-immun (PTA); cependant, les données quant à son innocuité pendant la grossesse sont limitées. Le présent cas illustre l’utilisation réussie du rituximab pour la prise en charge du PTA associé à la grossesse.

      Cas

      Une femme de 34 ans présentait un PTA grave à 23 semaines de gestation. Le traitement standard au moyen de corticostéroïdes, d’immunoglobuline intraveineuse et d’une splénectomie n’était pas parvenu à donner lieu à une hausse de la numération plaquettaire. En raison de la poursuite des saignements, du rituximab lui a été administré au cours de la 26e semaine de grossesse. La numération plaquettaire est alors passée à plus de 100 × 109/l après quatre semaines. La numération de lymphocytes B néonatale s’est normalisée à quatre mois à la suite de l’accouchement. Le traitement au rituximab n’a occasionné aucune complication néonatale.

      Conclusion

      Le rituximab pourrait s’avérer sûr pour la prise en charge du PTA associé à la grossesse. Ce cas souligne la nécessité de procéder à d’autres études sur l’innocuité et l’efficacité du rituximab pendant la grossesse.

      Key Words

      REFERENCES

        • Gill K.
        • Kelton J.
        Management of idiopathic thrombocytopenic purpura in pregnancy.
        Semin Hematol. 2000; 37: 275-289
        • Provan D.
        • Stasi R.
        • Newland A.
        • Blanchette V.S.
        • Bolton-Maggs P.
        • Bussel J.B.
        • et al.
        International consensus report on the investigation and management of primary immune thrombocytopenia.
        Blood. 2010; 115: 168-186
        • Cines D.
        • Blanchette V.
        Immune thrombocytopenic purpura.
        N Engl J Med. 2002; 346: 995-1008
        • Sukenik-Halevy R.
        • Ellis M.
        • Fejgin M.
        Management of immune thrombocytopenic purpura.
        Obstet Gynecol Surv. 2008; 63: 182-188
        • Temprano K.
        • Bandlamudi R.
        • Moore T.
        Antirheumatic drugs in pregnancy and lactation.
        Semin Arthritis Rheum. 2005; 35: 112-121
        • Brenner B.
        • Guilburd J.
        • Tatarsky I.
        • Doron Y.
        • Goldsher D.
        Spontaneous intracranial hemorrhage in immune thrombocytopenic purpura.
        Neurosurgery. 1988; 22: 761-764
        • Lee M.
        • Kim W.
        Intracranial hemorrhage associated with idiopathic thrombocytopenia purpura: report of seven patients and a meta-analysis.
        Neurology. 1998; 50: 1160-1163
        • Kojouri K.
        • Vesely S.
        • Deirda T.
        • George J.N.
        Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count response, prediction of response, and surgical complications.
        Blood. 2004; 104: 2623-2634
        • Felbinger T.
        • Posner M.
        • Eltzschig H.
        • Kodali B.S.
        Laparoscopic splenectomy in a pregnant patient with immune thrombocytopenic purpura.
        Int J Obstet Anesth. 2007; 16: 281-283
        • Gottlieb P.
        Splenectomy during pregnancy: an option in the treatment of autoimmune thrombocytopenia.
        Br J Obstet Gynaecol. 1999; 106: 373-375
        • Griffiths J.
        • Sia W.
        • Shapiro A.
        • Tataryn I.
        • Turner A.R.
        Laparoscopic splenectomy for the treatment of refractory immune thrombocytopenia in pregnancy.
        J Obstet Gynaecol Can. 2005; 27: 771-774
        • Iwase K.
        • Higaki J.
        • Yoon H.
        • Mikata S.
        • Tanaka Y.
        • Takahashi T.
        • et al.
        Hand-assisted laparoscopic splenectomy for idiopathic thrombocytopenic purpura during pregnancy.
        Surg Laparosc Endosc Percutan Tech. 2001; 11: 53-56
        • Varghese L.
        • Viswabandya A.
        • Mathew A.
        Dapsone, danazol, and intrapartum splenectomy in refractory ITP complicating pregnancy.
        Indian J Med Sci. 2008; 62: 452-455
        • Cerny T.
        • Borisch B.
        • Introna M.
        • Johnson P.
        • Rose A.L.
        Mechanism of action of rituximab.
        Anticancer Drugs. 2002; 13: S3-S10
        • Arnold D.
        • Dentali F.
        • Crowther M.
        • Meyer R.M.
        • Cook R.J.
        • Sigouin C.
        • et al.
        Systematic review: efficacy and safety of rituximab for adults with idiopathic thrombocytopenic purpura.
        Ann Intern Med. 2007; 146: 25-33
        • Godeau B.
        • Porcher R.
        • Fain O.
        • Lefrère F.
        • Fenaux P.
        • Cheze S.
        • et al.
        Rituximab efficacy and safety in adult splenectomy candidates with chronic immune thrombocytopenic purpura: results of a prospective multicenter phase 2 study.
        Blood. 2008; 112: 999-1004
        • Vinet E.
        • Pineau C.
        • Gordon C.
        • Clarke A.E.
        • Bernatsky S.
        Biologic therapy and pregnancy outcomes in women with rheumatic diseases.
        Arthritis Rheum. 2009; 61: 587-592
        • Pellkofer H.
        • Suessmair C.
        • Schulze A.
        • Hohlfeld R.
        • Kuempfel T.
        Course of neuromyelitis optica during inadvertent pregnancy in a patient treated with rituximab.
        Mult Scler. 2009; 15: 1006-1008
        • Klink D.
        • van Eldburg R.
        • Schreurs M.
        • van Well G.T.
        Rituximab administration in third trimester of pregnancy suppresses neonatal B-cell development.
        Clin Dev Immunol. 2008; 2008: 271363
        • Østensen M.
        • Lockshin M.
        • Doria A.
        • Valesini G.
        • Meroni P.
        • Gordon C.
        • et al.
        Update on safety during pregnancy of biological agents and some immunosuppressive anti-rheumatic drugs.
        Rheumatology. 2008; 47: iii28-iii31
        • Decker M.
        • Rothermundt C.
        • Hollander G.
        • Tichelli A.
        • Rochlitz C.
        Rituximab plus CHOP for treatment of diffuse large B-cell lymphoma during second trimester of pregnancy.
        Lancet Oncol. 2006; 7: 693-694
        • Carson K.R.
        • Evens A.M.
        • Richey E.A.
        • Habermann T.M.
        • Focosi D.
        • Seymour J.F.
        • et al.
        Progressive multifocal leukoencephalopathy after rituximab therapy in HIV-negative patients: a report of 57 cases from the Research on Adverse Drug Events and Reports project.
        Blood. 2009; 313: 4834-4840
        • Gheuens S.
        • Pierone G.
        • Peeters P.
        • Koralnik I.J.
        Progressive multifocal leukoencephalopathy in individuals with minimal or occult immunosuppression.
        J Neurol Neurosurg Psychiatry. 2010; 81: 247-254
        • Medeiros C.
        • Marini S.
        • Baptista M.
        • Guerra Jr., G.
        • Maciel-Guerra A.T.
        Turner’s syndrome and thyroid disease: a transverse study of pediatric patients in Brazil.
        J Pediatr Endocrinol Metab. 2000; 13: 357-362

      25. Saenger P. Clinical manifestations and diagnosis of Turner syndrome (gonadal dysgenesis). UpToDate 2009. Available at: http://www.uptodate.com/patients/content/topic.do?topicKey=~AcBnBTibV5GCb1n. Accessed September 22, 2010.

        • Holtrop P.
        The frequency of hypoglycemia in full-term large and small for gestational age newborns.
        Am J Perinatol. 1993; 10: 150-154
        • Sarici S.
        • Serdar M.
        • Korkmaz A.
        • Erdem G.
        • Oran O.
        • Tekinalp G.
        • et al.
        Incidence, course, and prediction of hyperbilirubinemia in near-term and term newborns.
        Pediatrics. 2004; 113: 775-780
        • Modi N.
        Hyponatremia in the newborn.
        Arch Dis Child Fetal Neonatal Ed. 1998; 78: F81-F84
        • Roberts I.
        • Stanworth S.
        • Murray N.
        Thrombocytopenia in the neonate.
        Blood Rev. 2008; 22: 173-186
        • Hohlfeld P.
        • Forestier F.
        • Kaplan C.
        • Tissot J.D.
        • Daffos F.
        Fetal thrombocytopenia: a retrospective survey of 5,194 fetal blood samples.
        Blood. 1994; 84: 1851-1856

      Article info

      Publication history

      Accepted: June 25, 2010
      Received: April 26, 2010

      Footnotes

      Competing Interests: None declared.

      Identification

      DOI: https://doi.org/10.1016/S1701-2163(16)34741-7

      Copyright

      © 2010 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

      ScienceDirect

      Access this article on ScienceDirect

      The content on this site is intended for healthcare professionals.


      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the Cookie Preference Center for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties.


      RELX