The long-term impact of rituximab for childhood immune thrombocytopenia

Rituximab administered at standard doses induces universal B-cell depletion. It shows good efficacy in patients with a variety of autoimmune diseases and has been licensed for use in rheumatoid arthritis. Despite prolonged B-cell depletion, side effects appear to be minimal. The use of B-cell depletion in children in whom the immune system is more immature may have other unknown complications, although the literature remains sparse. This review summarizes the available studies of rituximab in children with immune thrombocytopenia and assesses some of the short-term and potential long-term consequences of B-cell depletion. Overall, rituximab appears well-tolerated in children. The incidence of serum sickness may be higher than it is in adults, but infections remain infrequent and occur mostly in patients with an underlying predisposition to infections. Finally, although data remain limited, it is recommended to perform vaccinations before administration of rituximab or after B-cell return.