High response rate to low-dose rituximab plus high-dose dexamethasone as frontline therapy in adult patients with primary immune thrombocytopenia

Corticosteroids as initial therapy for primary immune thrombocytopenia achieve a low rate of sustained remission. Methods We prospectively evaluated the efficacy, safety, and response duration of low-dose rituximab plus high-dose dexamethasone as frontline therapy in newly diagnosed primary immune thrombocytopenia patients. One cycle of dexamethasone, 40mg/d/intravenously for four consecutive days, plus weekly intravenous rituximab, 100mg for four doses, was delivered. Results Twenty-one consecutive adults were enrolled. The overall response at day +28 was 90.5%. Complete sustained response at 6months and relapse rate were 76.2% and 15.8%, respectively, compared with 30% and 62.5% for a historical group who had received standard treatment with prednisone (P=0.005 and P=0.004). There was a 9.5% incidence of adverse effects. Conclusions The combination of low-dose rituximab and high-dose dexamethasone as frontline therapy for adults with primary immune thrombocytopenia was effective and had a high overall response rate and a low incidence of relapse.