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Rituximab Provided Long-Term Remission in a Patient with Refractory Relapsing Thrombotic Thrombocytopenic Purpura

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Abstract

We describe a 69-year-old man with refractory relapsing thrombotic thrombocytopenic purpura (TTP) successfully treated with rituximab. The patient had once been successfully treated with plasmapheresis and vincristine, but he had relapsed after a short period. Although plasmapheresis, vincristine, and splenectomy could not achieve a consistent elevation of the platelet count, rituximab administration provided sustained remission for more than 7 months. Rituximab should be considered as a therapeutic alternative for refractory TTP.

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References

  1. Bukowski RM. Thrombotic thrombocytopenic purpura: a review. Prog Hemost Thromb. 1982;6:287–337.

    CAS  PubMed  Google Scholar 

  2. Furlan M, Robles R, Galbusera M, et al. von Willebrand factor- cleaving protease in thrombotic thrombocytopenic purpura and the hemolytic-uremic syndrome. N Engl J Med. 1998;339:1578–1584.

    Article  CAS  PubMed  Google Scholar 

  3. Furlan M, Robles R, Solenthaler M, Wassmer M, Sandoz P, Lammle B. Deficient activity of von Willebrand factor-cleaving protease in chronic relapsing thrombotic thrombocytopenic purpura. Blood. 1997;89:3097–3103.

    CAS  PubMed  Google Scholar 

  4. Tsai HM, Lian EC. Antibodies to von Willebrand factor-cleaving protease in acute thrombotic thrombocytopenic purpura. N Engl J Med. 1998;339:1585–1594.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Rock GA, Shumak KH, Buskard NA, et al. Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura: Canadian Apheresis Study Group. N Engl J Med. 1991;325:393–397.

    Article  PubMed  CAS  Google Scholar 

  6. Shumak KH, Rock GA, Nair RC. Late relapse in patients successfully treated for thrombotic thrombocytopenic purpura: Canadian Apheresis Group. Ann Intern Med. 1995;44:2836–2840.

    Google Scholar 

  7. Bell WR. Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome relapse: frequency, pathogenesis, and meaning. Semin Hematol. 1997;34:134–139.

    PubMed  CAS  Google Scholar 

  8. Kuwaan HC, Soff GA. Management of thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. Semin Hematol. 1997;34:159–166.

    Google Scholar 

  9. Allford SL, Hunt BJ, Rose P, Machin SJ. Guidelines on the diagnosis and management of the thrombotic microangiopathic haemolytic anaemias. Br J Haematol. 2003;120:556–573.

    Article  PubMed  Google Scholar 

  10. Aqui NA, Stein SH, Konkle BA, Abrams CS, Strobl FJ. Role of splenectomy in patients with refractory or relapsed thrombotic thrombocytopenic purpura. J Clin Apheresis. 2003;18:51–54.

    Article  PubMed  Google Scholar 

  11. Hovinga JAK, Studt JD, Biasiutti FD, et al. Splenectomy in relapsing and plasma-refractory acquired thrombotic thrombocytopenic purpura. Br J Haematol. 2004;89:320–324.

    Google Scholar 

  12. Boye J, Elter T, Engert A. An overview of the current clinical use of the anti-CD20 monoclonal antibody rituximab. Ann Oncol. 2003;14:520–535.

    Article  PubMed  CAS  Google Scholar 

  13. Levine TD, Pestronk A. IgM antibody-related polyneuropathies: B-cell depletion chemotherapy using rituximab. Neurology. 1999; 52:1701–1704.

    Article  PubMed  CAS  Google Scholar 

  14. Stasi R, Pagano A, Stipa E, Amadori S. Rituximab chimeric anti- CD20 monoclonal antibody treatment for adults with chronic idio- pathic thrombocytopenic purpura. Blood. 2001;98:952–957.

    Article  PubMed  CAS  Google Scholar 

  15. Remmuzzi G, Chiuruchiu C, Abbate M,Brusegan V, Bontempelli M, Ruggenenti P. Rituximab for idiopathic membranous nephropathy. Lancet. 2002;360:923–924.

    Article  Google Scholar 

  16. Gutterman LA, Kloster B, Tsai HM. Rituximab therapy for refractory thrombotic thrombocytopenic purpura. Blood Cells Mol Dis. 2002;28:385–391.

    Article  PubMed  Google Scholar 

  17. Chemnitz J, Draube A, Scheid C, et al. Successful treatment of severe thrombotic thrombocytopenic purpura with the monoclonal antibody rituximab. Am J Hematol. 2002;71:105–108.

    Article  PubMed  CAS  Google Scholar 

  18. Zheng X, Pallera AM, Goodnough LT, Sadler JE, Blinder MA. Remission of chronic thrombotic thrombocytopenic purpura after treatment with cyclophosphamide and rituximab. Ann Intern Med. 2003;138:105–108.

    Article  PubMed  CAS  Google Scholar 

  19. Tsai HM, Shulman K. Rituximab induces remission of cerebral ischemia caused by thrombotic thrombocytopenic purpura. Eur J Haematol. 2003;70:183–185.

    Article  PubMed  Google Scholar 

  20. Yomtovian R, Niklinski W, Silver B, Sarode R, Tsai HM. Rituximab for chronic recurring thrombotic thrombocytopenic purpura: a case report and review of the literature. Br J Haematol. 2004;124:787–795.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Stein YG, Aeidman A, Fradin Z, Varon M, Cohen A, Mittelman M. Treatment of resistant thrombotic thrombocytopenic purpura with rituximab and cyclophosphamide. Int J Hematol. 2004;80:94–96.

    Article  PubMed  Google Scholar 

  22. Sugio Y, Okamura T, Shimoda K, et al. Ticlopidine-associated thrombotic thrombocytopenic purpura with an IgG-type inhibitor to von Willebrand factor-cleaving protease activity. Int J Hematol. 2001;74:347–351.

    Article  PubMed  CAS  Google Scholar 

  23. Kawahara M, Kanno M, Matsumoto M, Nakamura S, Fujimura Y, Ueno S. Diffuse neurodeficits in intravascular lymphomatosis with ADAMTS13 inhibitor. Neurology. 2004;63:1731–1733.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, Toyonaka Municipal Hospital, 1-14-1, Shibahara-cho, Toyonaka, 560-8565, Osaka, Japan

    Satoru Kosugi, Yasushi Ohtani, Hironori Take & Jun Kuyama

  2. Department of Blood Transfusion Medicine, Nara Medical University, Nara, Japan

    Masanori Matsumoto, Hiromichi Ishizashi & Yoshihiro Fujimura

Authors
  1. Satoru Kosugi
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  2. Masanori Matsumoto
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  3. Yasushi Ohtani
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  4. Hironori Take
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  5. Hiromichi Ishizashi
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  6. Yoshihiro Fujimura
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  7. Jun Kuyama
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Correspondence to Satoru Kosugi.

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Kosugi, S., Matsumoto, M., Ohtani, Y. et al. Rituximab Provided Long-Term Remission in a Patient with Refractory Relapsing Thrombotic Thrombocytopenic Purpura. Int J Hematol 81, 433–436 (2005). https://doi.org/10.1532/IJH97.04187

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  • DOI: https://doi.org/10.1532/IJH97.04187

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