CASE REPORT article
Front. Med.
Sec. Hematology
Combination of Anti-CD20 and Hetrombopag in Relapsed/Refractory Immune Thrombocytopenia: A Case Series
Provisionally accepted
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, Shijiazhuang, Hebei, China
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Purpose: This study aimed to assess the effectiveness of anti-CD20 monoclonal antibody and hetrombopag for relapsed/refractory immune thrombocytopenia (ITP) following glucocorticoid treatment. Methods: We retrospectively included four patients with relapsed/refractory ITP, the median disease duration is 9 months. Their prior lines of therapy numbered 4, 2, 4, and 2 respectively. They were treated with a combination of anti-CD20 monoclonal antibody and hetrombopag, followed by maintenance therapy with hetrombopag and monitoring of platelet (PLT) changes. Results: All four patients achieved complete response (CR), with the time to response ranging from 2 to 9 days and the duration of response (DoR) ranging from 3 to 27 months. CR was defined as a PLT count >100×109/L and the absence of bleeding. The treatment was well tolerated. Only the first patient's PLT count decreased to 31×10⁹/L following discontinuation of therapy after 6 months of DoR. Accordingly, the patient was treated with avatrombopag monotherapy, which maintained the PLT count at normal levels. The third patient presented secondary ITP. After treatment with ripertamab-hetrombopag, the patient received combination therapy with hetrombopag, glucocorticoids, tacrolimus, and hydroxychloroquine, with the PLT count being maintained within the normal range. The other two patients remained in sustained CR throughout the follow-up period. Conclusion: Combining anti-CD20 monoclonal antibody with hetrombopag may offer therapeutic benefits in patients with relapsed/refractory ITP.
Keywords: immune thrombocytopenia, Anti-CD20 monoclonal antibody, Hetrombopag, Relapsed/refractory, case series
Received: 09 Sep 2025; Accepted: 06 Nov 2025.
Copyright: © 2025 Zhang, Li, Guo, Zhou, Lin, Wang and Xing. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Yan Wang, 27400169@hebmu.edu.cn
Lina Xing, xinglina84@hebmu.edu.cn
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