Rituximab as first-line treatment for acquired thrombotic thrombocytopenic purpura
| Autor: | Longmei Qing, Zhengyang Li, Tianqin Wu, Qian Zhu, Jing-Jing Zhu, Hai-Fei Chen, Jing Wang, Ailin Fu, Hongshi Shen, Jie Li, Jie-Qing Tang |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male safety medicine.medical_specialty efficacy 030204 cardiovascular system & hematology thrombotic thrombocytopenic Biochemistry Gastroenterology Young Adult 03 medical and health sciences chemistry.chemical_compound rituximab 0302 clinical medicine plasma exchange Lactate dehydrogenase Internal medicine medicine Humans Platelet Clinical Note Adverse effect Purpura Aged Acquired Thrombotic Thrombocytopenic Purpura Purpura Thrombotic Thrombocytopenic business.industry Biochemistry (medical) Cell Biology General Medicine Middle Aged ADAMTS13 Surgery Schistocyte First line treatment chemistry 030220 oncology & carcinogenesis Female Rituximab business medicine.drug |
| Zdroj: | The Journal of International Medical Research |
| ISSN: | 1473-2300 0300-0605 |
| Popis: | Objective To investigate the efficacy and safety of rituximab (RTX) as first-line treatment of acquired thrombotic thrombocytopenic purpura (aTTP). Methods Twenty-five patients with acute aTTP and/or severe a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13) deficiency were admitted to our centre from April 2009 to March 2015. Fourteen patients received RTX plus standard therapy (plasma exchange and corticosteroids) at acute episodes. Haemoglobin, platelet count, schistocytes, lactate dehydrogenase levels, ADAMTS13 activity and its inhibitors, and the ratio of B lymphocytes in the peripheral blood, were monitored. The number of plasma exchange (PEXs), total plasma volume, remission time, relapse ratio, and adverse effects were recorded. Results The median number of PEXs was 5 (2–17) sessions and median total plasma volume was 168.43 ml/kg (62.86–469.52 ml/kg). Patients achieved haematological remission at a median of 15 days (5–22 days), and the median time of immunological remission was 2 weeks (2–8 weeks) with a median follow-up of 13 months (3–61 months). ADAMTS13 activity significantly increased after 2 weeks. The B lymphocyte percentage in peripheral blood was reduced 1 week after the first dose of RTX infusion compared with before treatment (2.21% ± 5.23% vs 18.47% ± 7.34%, P = 0.000 [the result of statistical software]), and began to gradually increase 9 months later. Severe adverse effects and relapsing TTP were not observed during therapy and follow-up. However, one patient who had sustained immunological remission died of severe pneumonia 7 months later. Conclusion Although our study was limited by its small sample number and it was a non-controlled, clinical trial, it showed potential benefits of RTX therapy for acute aTTP. RTX may be administered as a first-line therapy for lowering patients’ relapse rate in the long term. Randomized, controlled trials of RTX for aTTP are required. |
| Databáze: | OpenAIRE |
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