Comparison of low fixed dose versus standard-dose rituximab to treat thrombotic thrombocytopenic purpura in the acute phase and preemptively during remission |
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| Affiliation: | 1. Division of Transfusion Medicine and Hemostasis, Department of Pathology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA;2. Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA;1. Laboratory of Biotechnology, Protection and Valorization of Plant Resources, Phytochemistry and Pharmacology of Aromatic and Medicinal Plant Unit, Faculty of Science – Semlalia, Cadi Ayyad University, P.O. Box 2390, 40000, Marrakech, Morocco;2. Laboratory of Pharmacognosy and Ethnopharmacology, UMR-MD3, Faculty of Pharmacy, Aix-Marseille University, 27 Bd. Jean Moulin, CS 30064, 13385, Marseille Cedex 5, France;3. Laboratory of Parasitology, UMR MD3, Faculty of Pharmacy, Aix-Marseille University, 27 Bd. Jean Moulin, CS 30064, 13385, Marseille Cedex 5, France;1. Department of Internal Medicine, School of Medicine, University of São Paulo, Ribeirão Preto, Brazil;2. Bone Marrow Transplantation Unit, Hospital das Clínicas, School of Medicine, University of São Paulo, Ribeirão Preto, Brazil;1. Department of Internal Medicine, School of Medicine, University of São Paulo, Ribeirão Preto, Brazil;2. Bone Marrow Transplantation Unit, Hospital das Clínicas, School of Medicine, University of São Paulo, Ribeirão Preto, Brazil;1. Department of Internal Medicine, School of Medicine, University of São Paulo, Ribeirão Preto, Brazil;2. Bone Marrow Transplantation Unit, Hospital das Clínicas, School of Medicine, University of São Paulo, Ribeirão Preto, Brazil;1. Center for Cell-based Therapy and Regional Blood Center, Ribeirão Preto, Brazil;2. Department of Internal Medicine, School of Medicine, University of São Paulo, Ribeirão Preto, Brazil;1. Department of Internal Medicine, School of Medicine, University of São Paulo, Ribeirão Preto, Brazil;2. Bone Marrow Transplantation Unit, Hospital das Clínicas, School of Medicine, University of São Paulo, Ribeirão Preto, Brazil;1. University of Lyon, Faculty of Medicine of Saint-Etienne, Saint-Etienne, France;2. Institut National de la Transfusion Sanguine, Paris, France;1. Department of Leukemia, MD Anderson Cancer Center, TX, USA;2. Department of Hematology/Oncology, Columbia University Medical Center, NY, USA;3. Department of Stem Cell Transplant, MD Anderson Cancer Center, TX, USA |
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| Abstract: | The standard dose of rituximab used in B-cell hematological malignancies, 375 mg/m2 weekly, may be excessive for autoimmune conditions. Successful use of a low, fixed dose of 100−200 mg of rituximab, weekly for 4 weeks, has been reported in the literature in the treatment of autoimmune thrombotic thrombocytopenic purpura (aTTP). We retrospectively analyzed our rituximab data in aTTP over a 13-year-period for 39 patients, with the aim of comparing response and outcomes with a standard lymphoma-dose course versus a low fixed 100 mg-dose course. Compared to the standard dose (17 patients, 17 courses of 4 infusions), our patients who received a low dose (8 patients, 9 courses of 4 infusions) had a possibly lower baseline risk but did achieve a similar time to remission and number of plasma exchange procedures to remission. Preemptive low-dose courses for ADAMTS13 activity <50 % during remission (6 patients, 10 courses of 4 infusions) achieved a median peak ADAMTS13 activity of 99 %, in a median of 1 month, with no clinical relapses. Our results provide additional evidence for the efficacy of low-dose rituximab, with the benefit of much lower cost, less infusion time, and theoretically lower risk of toxicity. |
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| Keywords: | Thrombotic thrombocytopenic purpura TTP Rituximab Low dose Remission |
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