Corticosteroid treatment before and after rituximab therapy in the studied patients
| Patient . | Corticosteroid therapy previously used to treat the MC manifestations present at baseline . | Corticosteroid use after RTX (dose in PDN mg/d)3-150 . | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Duration . | CS monotherapy . | Effect . | 0 . | +1 . | +2 . | +3 . | +4 . | +5 . | +6 . | |
| 1 | PDN 25 mg/d in the previous 12 mos | Yes | Ineffective on any manifestation; PDN tapered and stopped before RTX | 0 | 0 | 0 | 0 | 25 | 25 | 25 |
| 2 | PDN up to 25 mg/d for 8 y | Yes | Mild improvement in purpura and urticaria; PDN tapered and stopped before RTX | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 3 | PDN up to 75 mg/d for 5 mos | No (CS + IVIG) | Partial efficacy on purpura; onset and worsening of ulcers and neuropathy | 25 | 0 | 0 | 0 | 0 | 0 | 0 |
| 4 | PDN up to 75 mg/d for 3 mos | Yes | Efficacy on immune anemia and neutropenia, but relapse after PDN suspension | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 5 | PDN 12.5 mg/d for 11 y | No (CS + AZA) | Partial efficacy on purpura; worsening of neuropathy | 5 | 5 | 0 | 0 | 0 | 0 | 0 |
| 6 | PDN up to 20 mg/d for 3 y | No (CS + PF; CS + IVIG) | Partial efficacy on purpura; worsening of neuropathy | 17.5 | 2.5 | 0 | 0 | 0 | 0 | 0 |
| 7 | PDN up to 25 mg/d for 12 y | No (CS + IFN; CS + Cy) | Ineffective | 12.5 | 0 | 0 | 0 | 0 | 0 | 0 |
| 8 | CVP chemotherapy 4 y before | No (CVP) | Partial decrease of hyperviscosity, then relapse | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 9 | PDN up to 10 mg/d for 8 y | Yes | Partial efficacy on purpura and arthralgias; neuropathy worsened | 5 | 0 | 0 | 0 | 0 | 0 | 0 |
| 10 | PDN up to 25 mg/d for short periods | Yes | Partial efficacy on purpura; onset of neuropathy and skin ulcers | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 11 | PDN up to 25 mg/d for 9 y | Yes | Sensory neuropathy worsened; then PDN tapered and stopped 12 mos before RTX, with onset of motor neuropathy and nephritis | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 12 | PDN up to 25 mg/d for 8 y | Yes | Partial efficacy on purpura; onset of skin ulcers; PDN tapered and stopped before RTX | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 13 | PDN up to 25 mg/d for 6 y | Yes | Partial efficacy on purpura; onset of skin ulcers; worsening of neuropathy | 2.5 | 1.25 | 0 | 0 | 0 | 0 | 0 |
| 14 | PDN up to 15 mg/d for 7 mos | Yes | Ineffective | 12.5 | 0 | 0 | 0 | 0 | 0 | 0 |
| 15 | PDN up to 12.5 mg/d for 15 y | Yes | Effective, but relapse for PDN doses <12.5 mg/d | 10 | 5 | 7.5 | 2.5 | 2.5 | 7.5 | 5 |
| Patient . | Corticosteroid therapy previously used to treat the MC manifestations present at baseline . | Corticosteroid use after RTX (dose in PDN mg/d)3-150 . | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Duration . | CS monotherapy . | Effect . | 0 . | +1 . | +2 . | +3 . | +4 . | +5 . | +6 . | |
| 1 | PDN 25 mg/d in the previous 12 mos | Yes | Ineffective on any manifestation; PDN tapered and stopped before RTX | 0 | 0 | 0 | 0 | 25 | 25 | 25 |
| 2 | PDN up to 25 mg/d for 8 y | Yes | Mild improvement in purpura and urticaria; PDN tapered and stopped before RTX | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 3 | PDN up to 75 mg/d for 5 mos | No (CS + IVIG) | Partial efficacy on purpura; onset and worsening of ulcers and neuropathy | 25 | 0 | 0 | 0 | 0 | 0 | 0 |
| 4 | PDN up to 75 mg/d for 3 mos | Yes | Efficacy on immune anemia and neutropenia, but relapse after PDN suspension | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 5 | PDN 12.5 mg/d for 11 y | No (CS + AZA) | Partial efficacy on purpura; worsening of neuropathy | 5 | 5 | 0 | 0 | 0 | 0 | 0 |
| 6 | PDN up to 20 mg/d for 3 y | No (CS + PF; CS + IVIG) | Partial efficacy on purpura; worsening of neuropathy | 17.5 | 2.5 | 0 | 0 | 0 | 0 | 0 |
| 7 | PDN up to 25 mg/d for 12 y | No (CS + IFN; CS + Cy) | Ineffective | 12.5 | 0 | 0 | 0 | 0 | 0 | 0 |
| 8 | CVP chemotherapy 4 y before | No (CVP) | Partial decrease of hyperviscosity, then relapse | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 9 | PDN up to 10 mg/d for 8 y | Yes | Partial efficacy on purpura and arthralgias; neuropathy worsened | 5 | 0 | 0 | 0 | 0 | 0 | 0 |
| 10 | PDN up to 25 mg/d for short periods | Yes | Partial efficacy on purpura; onset of neuropathy and skin ulcers | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 11 | PDN up to 25 mg/d for 9 y | Yes | Sensory neuropathy worsened; then PDN tapered and stopped 12 mos before RTX, with onset of motor neuropathy and nephritis | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 12 | PDN up to 25 mg/d for 8 y | Yes | Partial efficacy on purpura; onset of skin ulcers; PDN tapered and stopped before RTX | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 13 | PDN up to 25 mg/d for 6 y | Yes | Partial efficacy on purpura; onset of skin ulcers; worsening of neuropathy | 2.5 | 1.25 | 0 | 0 | 0 | 0 | 0 |
| 14 | PDN up to 15 mg/d for 7 mos | Yes | Ineffective | 12.5 | 0 | 0 | 0 | 0 | 0 | 0 |
| 15 | PDN up to 12.5 mg/d for 15 y | Yes | Effective, but relapse for PDN doses <12.5 mg/d | 10 | 5 | 7.5 | 2.5 | 2.5 | 7.5 | 5 |
RTX indicates rituximab; PDN, prednisone; CS, corticosteroids; IVIG, intravenous immunoglobulins; AZA, azathioprine; PF, plasmapheresis; IFN, interferon alpha; Cy, cyclophosphamide; and CVP, cyclophosphamide, vincristine, prednisone.
0, +1 to +6 refer to corticosteroid use at baseline and at the end of months +1 to +6 after the beginning of rituximab treatment.