OBJECTIVE AND IMPORTANCE: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder that needs prompt diagnosis and treatment. Front-line therapy consists of plasma exchange (PEx) and steroids, but, in some instances, this is not enough to achieve a complete and sustained response. CLINICAL PRESENTATION: We report four cases of TTP treated with low-dose rituximab, PEx, and a short course of steroids with an excellent outcome. Three of the patients had primary TTP and another presented an underlying human immunodeficiency virus infection. INTERVENTION: Rituximab, 100 mg intravenously, was initiated on days 2-8 from the start of PEx as first-line therapy in three cases and as salvage therapy for relapsing disease in one. The number of PEx needed ranged from 5 to 12 sessions. All patients achieved complete remission and are currently asymptomatic, with complete response duration of 8-22 months. CONCLUSION: Treatment of TTP with low-dose rituximab, along with PEx and steroids, seems to be as effective as the standard dose of monoclonal antibody.
OBJECTIVE AND IMPORTANCE: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder that needs prompt diagnosis and treatment. Front-line therapy consists of plasma exchange (PEx) and steroids, but, in some instances, this is not enough to achieve a complete and sustained response. CLINICAL PRESENTATION: We report four cases of TTP treated with low-dose rituximab, PEx, and a short course of steroids with an excellent outcome. Three of the patients had primary TTP and another presented an underlying human immunodeficiency virus infection. INTERVENTION: Rituximab, 100 mg intravenously, was initiated on days 2-8 from the start of PEx as first-line therapy in three cases and as salvage therapy for relapsing disease in one. The number of PEx needed ranged from 5 to 12 sessions. All patients achieved complete remission and are currently asymptomatic, with complete response duration of 8-22 months. CONCLUSION: Treatment of TTP with low-dose rituximab, along with PEx and steroids, seems to be as effective as the standard dose of monoclonal antibody.
Authors: Jingrui Sui; Wenjing Cao; Konstantine Halkidis; Mohammad S Abdelgawwad; Nicole K Kocher; Bryan Guillory; Lance A Williams; Radhika Gangaraju; Marisa B Marques; X Long Zheng Journal: Blood Adv Date: 2019-12-23
Authors: Halima El Omri; Ruba Y Taha; Amna Gamil; Firyal Ibrahim; Hisham Al Sabah; Zeinab O Mahmoud; Gianfranco Pittari; Ibrahim Al HIjji; Mohamed A Yassin Journal: Clin Med Insights Blood Disord Date: 2015-05-24