Rituximab for acute plasma-refractory thrombotic thrombocytopenic purpura. A case report and concise review of the literature

Rüfer, Axel; Brodmann, Doreen; Gregor, Michael; Kremer Hovinga, Johanna A; Lämmle, Bernhard; Wuillemin, Walter A (2007). Rituximab for acute plasma-refractory thrombotic thrombocytopenic purpura. A case report and concise review of the literature. Swiss medical weekly, 137(37-38), pp. 518-24. Muttenz: EMH Schweizerischer Ärzteverlag

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Thrombotic thrombocytopenic purpura (TTP) is a rare disease which responds well to plasma exchange treatment in the majority of patients. We report on a patient with acute TTP caused by severe autoantibody-mediated ADAMTS-13 deficiency, in whom remission was not achieved by initial treatment consisting of plasma exchange (PE), plasma infusion and corticosteroids, followed by vincristine and splenectomy. In view of the ongoing activity of TTP, treatment was initiated with rituximab, a chimaeric monoclonal antibody directed against the CD 20 antigen present on B lymphocytes. The patient received 4 weekly infusions of 375 mg/m2, each administered after the daily PE session and withholding PE until 48 hours later. Three weeks after the last infusion of rituximab a complete clinical and laboratory remission of this first episode of acute refractory TTP was documented. A concise review of the literature on the role of rituximab in patients with a first episode of acute plasma-refractory TTP suggests that rituximab in that situation may produce clinical remission in a significant proportion of patients, result in a lowered plasma requirement and avoid the complications of salvage immunosuppressive therapy. The use of rituximab in acute refractory TTP appears to be safe, with no excess infectious complications. We conclude that rituximab should be considered in TTP patients with acquired ADAMTS-13 deficiency who fail to respond clinically after 7-14 days of standard treatment with daily PE and glucocorticoids.

Item Type:	Journal Article (Further Contribution)
Division/Institute:	04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory
UniBE Contributor:	Kremer Hovinga Strebel, Johanna Anna, Lämmle, Bernhard
ISSN:	1424-7860
ISBN:	17990141
Publisher:	EMH Schweizerischer Ärzteverlag
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 14:54
Last Modified:	02 Mar 2023 23:22
PubMed ID:	17990141
Web of Science ID:	000250068300002
URI:	https://boris.unibe.ch/id/eprint/22896 (FactScience: 37611)