Therapeutic effects of rituximab combined with cyclophosphamide on refractory idiopathic thrombocytopenic purpura (ITP) were investigated. We retrospectively analyzed 249 patients with refractory ITP who were admitted to Qingdao Hiser Medical Group between March 2013 and March 2017. Curative effects of patients treated with rituximab, cyclophosphamide, and combination therapy were observed and the changes of platelet count, PA IgG, and lymphocyte CD20 before and after treatment, as well as the incidence of adverse reactions after treatment, were compared. There was no significant difference in the expression of lymphocyte CD20, PA IgG and platelet count among the three groups of refractory ITP patients before treatment (P>0.05). After treatment, the expression levels of CD20 and PA IgG in lymphocytes were significantly downregulated, and platelet counts significantly increased in the three groups (P<0.05). After treatment, CD20 and PA IgG levels in combined therapy group were significantly lower, and platelet count was significantly higher, than those in the rituximab and cyclophosphamide groups (P<0.05). Also, after rituximab treatment, the expression levels of CD20 and PA IgG in lymphocytes were significantly lower than those in cyclophosphamide group (P<0.05), and platelet count was higher than that in cyclophosphamide group (P<0.05). After treatment, the total effective rate in combined therapy group was higher than that in the rituximab and cyclophosphamide group (P<0.05). Total effective rate of rituximab group was significantly higher than that of cyclophosphamide group (P<0.05). The incidence of adverse reactions in combined therapy group was 14.29% (12/84), which was significantly lower than that in cyclophosphamide group (40.70%, 35/86, P<0.05) and rituximab group (29.11%, 23/79, P<0.05). The application of rituximab combined with cyclophosphamide in the treatment of refractory ITP can improve patients clinical symptoms. The efficacy of this technique is promising with no serious adverse reactions. This technique should be popularized in clinical practice.
Keywords: combined therapy; cyclophosphamide; efficacy; refractory idiopathic thrombocytopenic purpura; rituximab.