Absence of Viral Complications When Using Rituximab to Treat TTP with Plasma Exchange
Notice bibliographique
Résumé
Abstract INTRODUCTION Rituximab is widely used for the treatment of B cell lymphoma and, increasingly, for therapy in autoimmune diseases including TTP. One of the major concerns about this drug is that selectively depleting B-lymphocytes may increase the number of infections with reactivation of latent viruses such has Hepatitis B and Cytomegalovirus (CMV). Immunosuppression can result in increased susceptibility for HEV infection and chronic hepatitis. We have recently carried out a Phase II study in which Rituximabwas administered to 40 TTP patients with relapsing or refractory disease. These patients received very large volumes of non-inactivated plasma (range 50 to 110 litres), so it was considered possible that infection could occur. Therefore, we determined the viral status of the patients prior to, and after treatment. METHODS Forty patients, 20 refractory and 20 with relapsing TTP, were recruited from 4 apheresis centres. Each received 375 mg/m2 of Rituximab once a week for 4 weeks. Plasma exchange was initiated on day 0 and carried out daily for at least 7 of 10 days. Response to therapy was measured by platelet count. Tests for viral studies for hepatitis B core antigen and hepatitis E (which we recently reported to be transmitted during PE) were carried out at our National Viral Laboratories (location province). All but 1 patient who also got SDP received either cryosupernatant plasma or FFP in combination. Blood samples were taken on day 0 and repeated at 1, 12, 24 and 52 weeks for viral studies. RESULTS All patients decreased their CD20 values by week 2 and recovered fully by week 24. lgG levels were slightly decreased at week 2 in the relapsed patients but not in the refractory ones, then remained normal throughout testing. Three relapsing patients were strongly positive for anti-HEV at presentation however, the antibodies were all IgM negative ruling out recent infection. The HEV titres did not change during the period of assessment (52 weeks). One refractory patient was positive for anti-HEV lgG at 0 but negative by 4, 12 and 52 weeks. Two patients were weakly positive for anti-HEV. Of these, one refractory case showed a boost in titre at 24 weeks without producing lgM but no HEV RNA was found. At presentation, 3 other patients had borderline anti-HEV positive values. None of the 36 patients tested showed anti-HBc seroconversion for Hepatitis B at any point. Four weakly positive patients became negative. DISCUSSION Rituximab effectively caused immunosuppression in these TTP patients however, in spite of receiving very large volumes of untreated plasma, there was no evidence of overt infection or significant seroconversion except in the one case with an increase in IgG at 6 months. Immunoglobulin levels remained in the normal range in these patients because of the infusion of donor plasma suggesting a protective effect of the plasma and that maintenance of normal immunoglobulin levels through the use of IVIgG may be protective in other patients receiving Rituximab. Disclosures No relevant conflicts of interest to declare.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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