Low-dose rituximab for the treatment of acute thrombotic thrombocytopenic purpura: Report of four cases
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. Cli...
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| Veröffentlicht in: | Hematology (Luxembourg) 2013-07, Vol.18 (4), p.233-236 |
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| creator | Pequeño-Luévano, Myrna Villarreal-Martínez, Laura Jaime-Pérez, José Carlos Gómez-de-León, Andrés Cantú-Rodríguez, Olga Graciela González-Llano, Oscar Gómez-Almaguer, David |
| description | 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. |
| doi_str_mv | 10.1179/1607845412Y.0000000073 |
| format | Article |
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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.</description><identifier>ISSN: 1607-8454</identifier><identifier>EISSN: 1607-8454</identifier><identifier>DOI: 10.1179/1607845412Y.0000000073</identifier><identifier>PMID: 23432850</identifier><language>eng</language><publisher>England: Taylor & Francis</publisher><subject>Adolescent ; Adult ; Antibodies, Monoclonal, Murine-Derived - administration & dosage ; Antineoplastic Agents - administration & dosage ; Combined Modality Therapy ; Dose-Response Relationship, Drug ; Female ; Humans ; Plasma Exchange ; Purpura, Thrombotic Thrombocytopenic - blood ; Purpura, Thrombotic Thrombocytopenic - drug therapy ; Purpura, Thrombotic Thrombocytopenic - therapy ; Rituximab ; Steroids - administration & dosage ; Thrombotic thrombocytopenic purpura</subject><ispartof>Hematology (Luxembourg), 2013-07, Vol.18 (4), p.233-236</ispartof><rights>W. S. Maney & Son Ltd 2013 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c417t-3898cde1820b570d69a4ec563725cba8f49523278a5754e9c3e83e3ec0c92fdd3</citedby><cites>FETCH-LOGICAL-c417t-3898cde1820b570d69a4ec563725cba8f49523278a5754e9c3e83e3ec0c92fdd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,27933,27934</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23432850$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pequeño-Luévano, Myrna</creatorcontrib><creatorcontrib>Villarreal-Martínez, Laura</creatorcontrib><creatorcontrib>Jaime-Pérez, José Carlos</creatorcontrib><creatorcontrib>Gómez-de-León, Andrés</creatorcontrib><creatorcontrib>Cantú-Rodríguez, Olga Graciela</creatorcontrib><creatorcontrib>González-Llano, Oscar</creatorcontrib><creatorcontrib>Gómez-Almaguer, David</creatorcontrib><title>Low-dose rituximab for the treatment of acute thrombotic thrombocytopenic purpura: Report of four cases</title><title>Hematology (Luxembourg)</title><addtitle>Hematology</addtitle><description>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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Antibodies, Monoclonal, Murine-Derived - administration & dosage</subject><subject>Antineoplastic Agents - administration & dosage</subject><subject>Combined Modality Therapy</subject><subject>Dose-Response Relationship, Drug</subject><subject>Female</subject><subject>Humans</subject><subject>Plasma Exchange</subject><subject>Purpura, Thrombotic Thrombocytopenic - blood</subject><subject>Purpura, Thrombotic Thrombocytopenic - drug therapy</subject><subject>Purpura, Thrombotic Thrombocytopenic - therapy</subject><subject>Rituximab</subject><subject>Steroids - administration & dosage</subject><subject>Thrombotic thrombocytopenic purpura</subject><issn>1607-8454</issn><issn>1607-8454</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkE1PwzAMhiMEYmPwF6YeuXTko2lSbtPElzQJCcGBU5SmLitqm5KkGvv3dGwDbliRbNnvaysPQlOCZ4SI7IqkWMiEJ4S-zvA-BDtC4-0g3k6O_9QjdOb9O8aUYoFP0YiyhFHJ8Ri9Le06LqyHyFWh_6wanUeldVFYQRQc6NBAGyJbRtr0YWitnG1yGypzKM0m2A7aodH1bnj6OnqCzrpvU2l7FxntwZ-jk1LXHi72eYJebm-eF_fx8vHuYTFfxiYhIsRMZtIUQCTFORe4SDOdgOEpE5SbXMsyyThlVEjNBU8gMwwkAwYGm4yWRcEm6HK3t3P2owcfVFN5A3WtW7C9V4RlMmEc43SQpjupcdZ7B6Xq3PB_t1EEqy1k9Qey-oU8GKf7G33eQPFjO1AdBPOdoGoHlo1eW1cXKuhNbV3pdGsqr9g_R74AuOuNAg</recordid><startdate>20130701</startdate><enddate>20130701</enddate><creator>Pequeño-Luévano, Myrna</creator><creator>Villarreal-Martínez, Laura</creator><creator>Jaime-Pérez, José Carlos</creator><creator>Gómez-de-León, Andrés</creator><creator>Cantú-Rodríguez, Olga Graciela</creator><creator>González-Llano, Oscar</creator><creator>Gómez-Almaguer, David</creator><general>Taylor & Francis</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130701</creationdate><title>Low-dose rituximab for the treatment of acute thrombotic thrombocytopenic purpura: Report of four cases</title><author>Pequeño-Luévano, Myrna ; Villarreal-Martínez, Laura ; Jaime-Pérez, José Carlos ; Gómez-de-León, Andrés ; Cantú-Rodríguez, Olga Graciela ; González-Llano, Oscar ; Gómez-Almaguer, David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-3898cde1820b570d69a4ec563725cba8f49523278a5754e9c3e83e3ec0c92fdd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Antibodies, Monoclonal, Murine-Derived - administration & dosage</topic><topic>Antineoplastic Agents - administration & dosage</topic><topic>Combined Modality Therapy</topic><topic>Dose-Response Relationship, Drug</topic><topic>Female</topic><topic>Humans</topic><topic>Plasma Exchange</topic><topic>Purpura, Thrombotic Thrombocytopenic - blood</topic><topic>Purpura, Thrombotic Thrombocytopenic - drug therapy</topic><topic>Purpura, Thrombotic Thrombocytopenic - therapy</topic><topic>Rituximab</topic><topic>Steroids - administration & dosage</topic><topic>Thrombotic thrombocytopenic purpura</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pequeño-Luévano, Myrna</creatorcontrib><creatorcontrib>Villarreal-Martínez, Laura</creatorcontrib><creatorcontrib>Jaime-Pérez, José Carlos</creatorcontrib><creatorcontrib>Gómez-de-León, Andrés</creatorcontrib><creatorcontrib>Cantú-Rodríguez, Olga Graciela</creatorcontrib><creatorcontrib>González-Llano, Oscar</creatorcontrib><creatorcontrib>Gómez-Almaguer, David</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Hematology (Luxembourg)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pequeño-Luévano, Myrna</au><au>Villarreal-Martínez, Laura</au><au>Jaime-Pérez, José Carlos</au><au>Gómez-de-León, Andrés</au><au>Cantú-Rodríguez, Olga Graciela</au><au>González-Llano, Oscar</au><au>Gómez-Almaguer, David</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Low-dose rituximab for the treatment of acute thrombotic thrombocytopenic purpura: Report of four cases</atitle><jtitle>Hematology (Luxembourg)</jtitle><addtitle>Hematology</addtitle><date>2013-07-01</date><risdate>2013</risdate><volume>18</volume><issue>4</issue><spage>233</spage><epage>236</epage><pages>233-236</pages><issn>1607-8454</issn><eissn>1607-8454</eissn><abstract>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.</abstract><cop>England</cop><pub>Taylor & Francis</pub><pmid>23432850</pmid><doi>10.1179/1607845412Y.0000000073</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Hematology (Luxembourg), 2013-07, Vol.18 (4), p.233-236 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adolescent Adult Antibodies, Monoclonal, Murine-Derived - administration & dosage Antineoplastic Agents - administration & dosage Combined Modality Therapy Dose-Response Relationship, Drug Female Humans Plasma Exchange Purpura, Thrombotic Thrombocytopenic - blood Purpura, Thrombotic Thrombocytopenic - drug therapy Purpura, Thrombotic Thrombocytopenic - therapy Rituximab Steroids - administration & dosage Thrombotic thrombocytopenic purpura |
| title | Low-dose rituximab for the treatment of acute thrombotic thrombocytopenic purpura: Report of four cases |
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