B CELL DEPLETION FOR AUTOIMMUNE THROMBOCYTOPENIA AND AUTOIMMUNE HEMOLYTIC ANEMIA IN PEDIATRIC SYSTEMIC LUPUS ERYTHEMATOSUS

Background: Preliminary data has shown that rituximab therapy has been shown to be effective in adults with SLE likely as a result of prolonged B cell depletion induced by rituximab. To date there have very few published series of the use of rituximab in patients with pSLE and the majority of patients received concomitant immunosuppressive therapy.Objectives: To determine long-term efficacy and safety of B cell depletion therapy in children with AITP and AIHA in pediatric SLE.Methods: Retrospective chart review of 8 children treated with rituximab for AITP and AIHA with pSLE.Results: Of the 8 children, 4 had AITP, 3 AIHA and 1 both. There were 5 female and 3 male with a mean age at the time of diagnosis of 14.4 years (12-16 years). The mean disease duration to time of rituximab treatment was 11.8 months (range 1-33 months). Treatment efficacy: Complete response (CR) was achieved in all 5 children with AITP; mean time to CR was 4 weeks with a median of 2 weeks (range 1-12 weeks). 2 children flared at 48 and 68 weeks respectively and were retreated. The remaining 3 children remained in remission at 24, 32 and 88 weeks respectively. All 4 children with AIHA had complete response with a mean time to attain CR of 14 weeks with a median of 4 weeks (range 4-32 weeks). All patients remained in CR at 24, 44, 84 and 100 weeks of follow-up. Immunosuppressive medications were decreased in all patients. Complete B cell depletion was achieved in all children following rituximab. Treatment safety: Partial hypogammaglobulinemia was seen in all children following rituximab. No serious infections or serious adverse events were noted.Conclusion: B cell depletion therapy with rituximab is an efficacious and safe treatment for AITP and AIHA in pSLE. The majority of children achieved complete remission for at least 9 months. Despite prolonged effect on B-cell numbers and function, no serious infections were observed.Citation: Ann Rheum Dis, volume 67, supplement II, year 2008, page 275Session: Paediatric rheumatology