Document Detail


Rituximab therapy for refractory thrombotic thrombocytopenic purpura.
MedLine Citation:
PMID:  12367582     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
While most patients of thrombotic thrombocytopenic purpura (TTP) respond to plasma exchange and achieve remission, a subset of the patients experience multiple relapses or develop a persistent disease that may be debilitating and life threatening. We report the experience of rituximab treatment in three consecutive patients who had required periodic plasma exchange for greater than 50-180 days after failing other modalities of treatments. Two patients each received eight doses of rituximab infusion and had clinical remissions that have lasted for 23 months and ongoing in one patient and for 17 months before relapse in the other. The third patient received four doses of rituximab infusion and had improvement of disease for 60 days until her death from unrelated causes. Analysis of the von Willebrand factor-cleaving metalloprotease activity (ADAMTS13) and its inhibitor in two patients showed that rituximab treatment was associated with a rise of the protease level and a decrease of the inhibitor titers in one patient who achieved clinical remission and a decrease of the inhibitor titer but no increase in protease level in the other patient who had a partial response. Based on the responses to rituximab and its mild toxicity in these three patients, and the lack of effective alternative treatments, additional exploration of the role of rituximab in the treatment of refractory TTP is warranted.
Authors:
Lorence A Gutterman; Bruce Kloster; Han-Mou Tsai
Publication Detail:
Type:  Case Reports; Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Blood cells, molecules & diseases     Volume:  28     ISSN:  1079-9796     ISO Abbreviation:  Blood Cells Mol. Dis.     Publication Date:    2002 May-Jun
Date Detail:
Created Date:  2002-10-07     Completed Date:  2003-07-14     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  9509932     Medline TA:  Blood Cells Mol Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  385-91     Citation Subset:  IM    
Affiliation:
Mid Ohio Oncology/Hematology Inc., Columbus, USA.
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MeSH Terms
Descriptor/Qualifier:
ADAM Proteins
Antibodies, Monoclonal / administration & dosage,  pharmacology,  therapeutic use*
Female
Hematologic Tests
Humans
Metalloendopeptidases / blood,  drug effects
Middle Aged
Plasma Exchange
Purpura, Thrombotic Thrombocytopenic / drug therapy*,  therapy
Recurrence / prevention & control
Remission Induction / methods
Salvage Therapy
Grant Support
ID/Acronym/Agency:
R01 HL62131/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/rituximab; EC 3.4.24.-/ADAM Proteins; EC 3.4.24.-/ADAMTS13 protein, human; EC 3.4.24.-/Metalloendopeptidases

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