David Green, MD, PhD reviewing Page EE et al. Blood 2016 Jun 16.

Adding rituximab to plasma exchange and steroids improved relapse-free survival in a nonrandomized trial.

Previous studies reported that adding rituximab to plasma exchange (PEX) and steroids for patients with thrombotic thrombocytopenic purpura (TTP) decreased hospital stay and the frequency of relapse (NEJM JW Oncol Hematol Sep 2011 and Blood 2011; 118:1746). However, these were small, nonrandomized studies that used historical controls.

To further examine whether patients with idiopathic TTP receiving rituximab as well as PEX and steroids have better outcomes than patients not receiving rituximab, investigators reviewed the records of all 41 patients in the Oklahoma TTP registry. These patients were treated between 2003 and 2014, and all had severe disease (ADAMTS13 activity, >10%).

Rituximab was given to 16 patients, either because of failure to respond to PEX and steroids or because of recurrence of thrombocytopenia when PEX was stopped. Rituximab recipients had improved relapse-free survival compared with nonrecipients (P=0.009). However, rituximab recipients had a longer course of PEX (median number of treatments, 16 vs. 8; P<0.01; median duration, 21 vs. 8 days, P<0.01) and received more steroids (median total dose, 3975 mg vs. 2135 mg; P=0.03).

CITATION(S):

Page EE et al. Rituximab reduces risk for relapse in patients with thrombotic thrombocytopenic purpura. Blood 2016 Jun 16; 127:3092

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