Efficacy of Rituximab in the Treatment of Plasma Exchange Refractory Thrombotic Thrombocytopenic Purpura

Rituximab can induce a durable remission in plasma exchange refractory thrombotic thrombocytopenic purpura (TTP). Timing of Rituximab infusion in combination with plasma exchange (PE) and long term follow-up for probable side effects of such treatment is still lacking. Methods: This study was conducted among 10 patients with plasma exchange refractory TTP. According to the study designation, first PE was performed within 36-48 hours after first dose of rituximab. Results: Eight of ten (80%) patients received 1 course of rituximab. Two of ten (20%) patients received another course of rituximab due to relapse. Repsonse rate (RR) to rituximab in combination with plasma exchange, was 90%. Overall Survival of the patients was 90% and 1 and 5-year relapse free survival rate (RFS) was 90% and 83%, respectively. One of the patients expired due to Systemic Lupus Erythematosus flare up. Conclusion: According to this study, treatment of refractory TTP with rituximab in combination with PE could be effective. Iranian Registry of Clinical Trials: IRCT2017012232125N1