Effect of rituximab on clinical and laboratory features of antiphospholipid syndrome: a case report and a review of literature

Abstract

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by a hypercoagulable state related to persistently elevated levels of antiphospholipid antibodies (aPL). Current treatment for APS is only partially effective and new therapies are strongly needed.

We report on a case of a 50 years old man with APS who suffered from recurrent thromboembolic episodes despite conventional anticoagulant treatment. Eight years after the first thrombotic manifestation he was diagnosed with a large B cell non-Hodgkin lymphoma. Treatment with CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) plus rituximab was started with partial clinical remission of lymphoma and normalization of aPL levels with a three years follow-up period free of thrombotic episodes.

A review of the literature revealed that only 12 case reports on the use of rituximab in patients with primary, secondary and catastrophic APS have been published. Current knowledge clearly suggests the need for clinical trials to evaluate the effect of rituximab in the treatment of resistant APS. Lupus (2008) 17, 50—55.

Keywords

anticardiolipin (antibodies)antiphospholipid antibodies rituximab lupus anticoagulant lymphoma

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References

Hughes G. The antiphospholipid syndrome: Ten years on. Lancet 1993; 342: 341—344.

Veneri D. , Ambrosetti A. , Franchini M. , Mosna F. , Poli G. , Pizzolo G. Remission of severe antiphospholipid syndrome associated with non-Hodgkin B cell lymphoma after combined treatment with rituximab and chemotherapy. Haematologica 2005; 90: 16—17.

Wilson WA , Gharavi AE , Koike T. et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthrits Rheum 1999; 42: 1309—1311.

Trappe R. , Loew A. , Thuss-Patience P. , Dörken B. , Riess H. Successful treatment of thrombocytopenia in primary antiphospholipid antibody syndrome with the anti-CD20 antibody rituximab-monitoring of antiphospholipid and anti-GP antibodies: a case report. Ann Hematol 2006; 85: 134—135.

Tomietto P. , Gremese E. , Tolusso B. , Venturini P. , De Vita S. , Ferraccioli G. B cell depletion may lead to normalization of antiplatelet, anti-erythrocyte and antiphospholipid antibodies in systemic lupus erythematosus. Thromb Haemost 2004 ; 92: 1150—1153.

Rubenstein E. , Arkfeld D. , Metyas S. , Shinada S. , Ehresmann S. , Liebman HA Rituximab treatment for resistant antiphospholipid syndrome. J Rheumatol 2006; 33: 355—357.

Ames Prj , Tommasino C. , Fossati G. , Scenna G. , Brancaccio V. , Ferrara F. Limited effect of rituximab on thrombocytopenia and anticardiolipin antibodies in a patient with primary antiphospholipid syndrome. Ann Hematol 2007; 86: 227—228.

Cooper N. , Stasi R. , Cunningham-Rundles S. et al. The efficacy and safety of B cell depletion with anti-CD20 monoclonal antibody in adults with chronic immune thrombocytopenic purpura. Br J Hematol 2004; 125: 232—239.

Braendstrup P. , Bjerrum OW , Nielsen OJ et al. Rituximab chimeric anti-CD20 monoclonal antibody treatment for adult refractory idiopathic thrombocytopenic purpura . Am J Hematol 2005; 78: 275—280.

10.

Erdozain JG , Ruiz-Irastorza G. , Egurbide MV , Aguirre C. Sustained response to rituximab of autoimmune haemolytic anaemia associated with antiphospholipid syndrome. Haematologica 2004; 89: ECR34.

11.

Ahn ER , Lander G. , Bidot C. , Wenche Jy, Ahn YS. Long-term remission from life-threatening hypercoagulable state associated with lupus anticoagulant (LA) following rituximab therapy . Am J Hematol 2005; 78: 127—129.

12.

Manz RA , Arce S. , Cassese G. , Hauser AE , Hiepe F. , Radbruch A. Humoral immunity and long-lived plasma cells. Curr Opinion Immunol 2002; 14: 517—521.

13.

Lim W. , Crowther MA , Eikelboom JW Management of antiphospholipid syndrome. JAMA 2006; 295: 1050—1057.

14.

Harner KC , Jackson LW , Drabick JJ Normalization of anticardiolipin antibodies following rituximab therapy for marginal zone lymphoma in a patient with Sjögren's syndrome. Rheumatology 2004; 43: 1309—1310.

15.

Weide R. , Heymanns J. , Pandorf A. , Koppler H. Successful long-term treatment of systemic lupus erythematosus with rituximab maintenance therapy. Lupus 2003; 12: 779—782.

16.

Leandro MJ , Edwards JC , Cambridge G. Clinical outcome in 22 patients with rheumatoid arthritis treated with B lymphocyte depletion. Ann Rheum Dis 2002; 61: 863—866.

17.

Anandacoomarasamy A. , Gibson J. , Mc Gill N. “Cure” of life-threatening antiphospholipid syndrome with rituximab. Intern Med J 2006; 36: 474—475.