[PAGID] Cellcept for ITP and CVID

[Cowan, Mort]

Our experience with Rituxan is very similar in patients with AIHA post BMT, i.e., it usually takes several weeks after the completion of a course before one sees a response.

Mort

Morton J. Cowan, M.D.
Professor of Pediatrics
Chief, BMT Division
UCSF Children's Hospital, Room M659
505 Parnassus Ave
San Francisco, CA 94143-1278
 
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-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Torgerson, Troy
Sent: Wednesday, May 07, 2008 12:17 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [PAGID] Cellcept for ITP and CVID

Chris,

You mention that she "just" got her last dose of Rituxan - in our most recent patient, we didn't see the improvement in platelet counts until about 6 weeks after the 4th dose.  The meta-analysis of Rituxan for ITP papers suggests that a fair percentage of patients don't get the benefit until late (2-3 months) after the 4th dose.  It may take that long for those rogue autoantibody-producing plasma cells to die off or poop out since they don't express CD20 and probably don't get cleared by the Rituxan.

TT

Troy R. Torgerson MD PhD
Attending Physician, Pediatric Immunology/Rheumatology
Co-Director Immunodeficiency Molecular Diagnostics Laboratory
University of Washington and Children's Hospital
1900 9th Avenue
Seattle, WA  98101-1304
 
Tel (206) 987-7450
Fax (206) 987-7310
-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Chris Seroogy
Sent: Wednesday, May 07, 2008 11:45 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [PAGID] Cellcept for ITP and CVID

Dear Mel,

375 mg/m2 weekly x 4.  Her spleen is normal in size per physical exam.
Chris


On 5/7/08 1:34 PM, "Berger, Melvin" <Melvin.Berger at UHhospitals.org> wrote:


> You don't give details, but have you tred pushing the dose of Rituxin ? We

> have had very good success with Rituxin in CVID patients with cytopenia. Since

> they are already on IGIV we don't worry so much about it having adverse effecs

> on protective antibody responses.

> 

> Does the patient have a big spleen ?

> 

> Mel Berger

> 

> -----Original Message-----

> From: pagid-bounces at list.clinimmsoc.org

> [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Chris Seroogy

> Sent: Wednesday, May 07, 2008 11:46 AM

> To: pagid at list.clinimmsoc.org

> Subject: [PAGID] Cellcept for ITP and CVID

> 

> Hello,

> 

> Has anyone had success using cellcept for ITP in CVID patients?  I have a

> teenager who presented a number of years ago with ITP and AIHA.  She

> fulfills the criteria for CVID and is on IVIG.  She had a recent flare in

> her ITP and failed increasing her IVIG.  She was started on prednisone and

> rituxan.  She just finished her fourth cycle of rituxan and is tapering on

> her prednisone.  She responded nicely (I think more to the steroids than the

> rituxan since the response was early and rapid) but now her platelets are

> slowly dropping.  As opposed to offering splenectomy, I was thinking of

> cellcept since I think the risk/benefit is better in general.  Thank you for

> sharing your experiences.  Chris

> 

> 

> Chris Seroogy, M.D.

> 

> University of Wisconsin

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