Rituximab, anti-CD20 chimeric monoclonal antibody directed against the CD20 antigen on B lymphocytes, induces a targeted B lymphocytes depletion in the aim of eradicating autoreactive clones in various autoimmune disorders. Because of its biological properties, it has been used as a treatment option for a variety of autoimmune diseases. We report two complicated patients: a 26-year-old female with steroid induced Cushing's syndrome and avascular necrosis of both femur heads, and a 56-year-old female with multiple spine compression fractures due to osteoporosis, diabetes mellitus and cataracts. They had long lasting, more than 10 years, lupus-associated hemolytic anemia and Evans syndrome, refractory to corticosteroids and immunosuppressive agents. The patients were treated with Rituximab, 375mg/m2 once weekly for 3 consecutive weeks. They showed a remarkable recovery about 5th week and have been free of transfusion after the treatment with Rituximab. Therapy was well tolerated, and no infectious complications occurred. They are still in complete remission at 20 and 4 months following the treatment, respectively. We suggest that Rituximab can be a valuable agent in the management of autoimmune cytopenias refractory to standard treatments.

Keywords: Rituximab, Anti-CD20, Autoimmune disease, Cytopenia