Treatment of chronic autoimmune thrombocytopenic purpura with monoclonal anti-D
1996
Background: The platelet count increases transiently after treatment with polyclonal anti-D in about 50 percent of D+ patients with autoimmune thrombocytopenic purpura (AITP). The effect is usually attributed to macrophage Fc-receptor blockade by antibody-coated red cells. As polyclonal anti-D is in limited supply, prospective testing was performed on a monoclonal anti-D (MoAb D) in such patients.
Study Design and Methods: Seven D+ patients with chronic AITP received MoAb D intravenously at doses of 47 to 95 μg per kg of body weight. Response was assessed by studying platelet count increment. Hemolysis and red cell-bound MoAb D were measured before and after MoAb D administration.
Results: MoAb D red cell binding was demonstrated in all patients at a ratio higher than that observed in AITP patients successfully treated with polyclonal anti-D. However, little or no platelet count increment was observed in six patients, while a transient response was observed in only one (platelet count 97 × 109/L before MoAb D infusion and 163 × 109/L 4 days later). Furthermore, because five patients showed signs of hemolysis and two became anemic, higher doses of MoAb D should be used only with caution in patients with AITP.
Conclusion: The MoAb D used in this study cannot be proposed as an alternative treatment for patients with AITP.
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