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Prepublished online as a Blood First Edition Paper on January 30, 2003; DOI 10.1182/blood-2002-09-2856. This Article Full Text Full Text (PDF) All Versions of this Article: 2002-09-2856v1 101/10/3827    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Zaja, F. Articles by Ferraccioli, G. Search for Related Content PubMed PubMed Citation Articles by Zaja, F. Articles by Ferraccioli, G. Related Collections Immunotherapy Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  Blood, 15 May 2003, Vol. 101, No. 10, pp. 3827-3834 CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS Efficacy and safety of rituximab in type II mixed cryoglobulinemia Francesco Zaja, Salvatore De Vita, Cesare Mazzaro, Stefania Sacco, Daniela Damiani, Ginevra De Marchi, Angela Michelutti, Michele Baccarani, Renato Fanin, and Gianfranco Ferraccioli From the Divisions of Hematology-Dipartimento di Ricerche Mediche e Morfologiche and of Rheumatology-Dipartimento di Patologia e Medicina Sperimentale e Clinica, University of Udine, Italy; Department of Medicine, Hospital of Pordenone, Italy; Institute of Hematology and Medical Oncology L. A. Seragnoli, University of Bologna, Italy. The best treatment of type II mixed cryoglobulinemia (MC) has still to be defined. Antiviral treatment for the frequent underlying infectious trigger hepatitis C virus (HCV) may be ineffective, contraindicated, or not tolerated in a fraction of cases, whereas current immunosuppressive treatments may lead to relevant complications. Selective B-cell blockade with rituximab was used in this study, based on favorable results in preliminary experience. Fifteen consecutive patients with type II MC (HCV-related in 12 of 15) were treated with rituximab, 375 mg/m2 intravenously weekly for 4 weeks. Only medium- to low-dose steroids were allowed, if already administered at the time of recruitment. All patients had active disease, poorly controlled or difficult to manage with previous treatments, including corticosteroids in all. Efficacy and safety of rituximab therapy were evaluated in the following 6 months. The overall follow-up after rituximab treatment ranged from 9 to 31 months. Rituximab proved effective on skin vasculitis manifestations (ulcers, purpura, or urticaria), subjective symptoms of peripheral neuropathy, low-grade B-cell lymphoma, arthralgias, and fever. Nephritis of recent onset went into remission in one case. Laboratory features, that is, significantly decreased serum rheumatoid factor and cryoglobulins and increased C4, were consistent with the clinical efficacy. Treatment was well tolerated, with no infectious complications. Thrombosis of retinal artery or self-limiting panniculitis occurred in one patient each. Rituximab may represent a safe and effective alternative to standard immunosuppression in type II MC. Controlled studies are needed to better define drug indications and the cost-efficacy profile in the different systemic manifestations. © 2003 by The American Society of Hematology.   CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: F. Zaja, M. L. 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