Rituximab as an adjunct to plasma exchange in TTP: a report of 12 cases and review of literature

Journal of Clinical Apheresis
Sushama JastiBernard Poiesz

Abstract

Idiopathic thrombotic thrombocytopenic purpura (TTP) is caused by the production of autoantibodies against the Von Willebrand factor cleaving enzyme. This provides a rationale for the use of rituximab in this disease. We report a retrospective review of 12 patients treated with rituximab for TTP refractory to plasma exchange. Eleven patients were treated during initial presentation, and one patient was treated for recurrent relapse. Ten patients responded to treatment. Median time to response after first dose of rituximab was 10 days (5-32). Of the 11 patients treated during initial presentation, nine remain free of relapse after a median follow-up of 57+ months (1+-79+). Two patients died during initial treatment. One patient was lost to follow-up 1 month after achieving complete response. The patient treated for recurrent disease during second relapse remained disease free for 2years, relapsed and was treated again with rituximab, and was in remission for 22 months. She relapsed again, was retreated, and has now been in remission for 21+ months. We conclude that rituximab is an useful addition to plasma exchange treatment in TTP, but its exact role and dosing need to be verified in prospective studies.

References

Jul 1, 1966·Naika. Internal medicine·Y SugaM Nomura
Nov 26, 1998·The New England Journal of Medicine·H M Tsai, E C Lian
Aug 23, 2002·The New England Journal of Medicine·Joel L Moake
Sep 28, 2002·American Journal of Hematology·Jens ChemnitzDietmar Söhngen
Oct 9, 2002·Blood Cells, Molecules & Diseases·Lorence A GuttermanHan-Mou Tsai
Jan 17, 2003·Annals of Internal Medicine·Xinglong ZhengMorey A Blinder
Feb 28, 2003·European Journal of Haematology·Han-Mou Tsai, Keith Shulman
Mar 22, 2003·Annals of Oncology : Official Journal of the European Society for Medical Oncology·J BoyeA Engert
Feb 19, 2004·Annals of Internal Medicine·Fadi FakhouriAgnès Veyradier
Mar 11, 2004·British Journal of Haematology·Roslyn YomtovianHan-Mou Tsai
Apr 22, 2004·Journal of Thrombosis and Haemostasis : JTH·S SallahN P Nguyen
Aug 6, 2004·International Journal of Hematology·Gideon Y SteinMoshe Mittelman
Sep 25, 2004·American Journal of Hematology·Afaq AhmadGeraldine P Schechter
Nov 2, 2004·Annals of Hematology·Pavan S ReddyMervin A Sahud
Nov 13, 2004·Annals of Hematology·Jimmy RuizPrabodh C Shah
Nov 25, 2004·Hematology·J Evan SadlerJames N George
Jan 13, 2006·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Fadi FakhouriAurélie Hummel
Apr 9, 2008·Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases·Deepak GuptaBarry Gruber

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Citations

Oct 29, 2011·Medizinische Klinik, Intensivmedizin und Notfallmedizin·L Engelmann
Apr 29, 2009·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Jumana H AlbaramkiStephen I Alexander
Sep 30, 2010·Medizinische Klinik·Regina HermannGunter Wolf
May 17, 2011·European Journal of Internal Medicine·Wilma Barcellini, Alberto Zanella
Mar 20, 2009·La Presse médicale·Guillaume BussoneLuc Mouthon
Sep 1, 2015·La Revue de médecine interne·Q ReynaudP Cathébras
May 20, 2009·International Journal of Laboratory Hematology·M A Scully, S J Machin
Jun 23, 2009·Pediatric Blood & Cancer·Maria C BouwNicole L Ramakers-van Woerden
Feb 18, 2011·American Journal of Hematology·Daan DierickxDrew Provan
Jul 17, 2013·Journal of Clinical Apheresis·Jatinder GoyalMarisa B Marques
Jan 7, 2014·British Journal of Haematology·Marie Scully, Tim Goodship
Aug 22, 2015·European Journal of Internal Medicine·Antoine FroissartUNKNOWN French Reference Center for Thrombotic Microangiopathies
Mar 19, 2015·Blood·Farzana A Sayani, Charles S Abrams
Dec 31, 2014·La Revue de médecine interne·G SauvètreY Benhamou
Mar 3, 2010·Thrombosis Research·Anna Maria LombardiFabrizio Fabris
Feb 26, 2016·American Journal of Hematology·Bashiar ThejeelAinslie M Hildebrand
Dec 8, 2015·Hematology·Paul CoppoUNKNOWN French Reference Center for Thrombotic Microangiopathies
Jan 24, 2017·Transfusion and Apheresis Science : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis·Paul Coppo, UNKNOWN French Reference Center for Thrombotic Microangiopathies
Apr 19, 2017·Blood·Bérangère S JolyAgnès Veyradier
Sep 13, 2018·Transfusion·William E PlautzMatthew D Neal
Oct 24, 2009·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Len VerbekeDaan Dierickx
Apr 14, 2012·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Roberto C Montoya, Bernard J Poiesz
Nov 10, 2011·Pediatric Emergency Care·Alex KoyfmanVincent W Chiang
Apr 18, 2009·Southern Medical Journal·Anil PatelAnush Patel
Apr 4, 2020·Expert Review of Hematology·Andrés Gómez-De LeónDavid Gómez-Almaguer
Jun 1, 2012·Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases·Tuan Van MaiMarin Xavier
Feb 26, 2020·Therapeutic Advances in Hematology·Ashley Hanlon, Ara Metjian
Apr 7, 2017·Nature Reviews. Disease Primers·Johanna A Kremer HovingaKaren Vanhoorelbeke
Mar 15, 2021·Transfusion and Apheresis Science : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis·César David Galindo-CalvilloDavid Gómez-Almaguer
Oct 18, 2013·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Yalcin SolakKadir Acar

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