Case Report Successful treatment of thrombotic thrombocytopenic purpura using low-dose rituximab combined with plasmapheresis: three case reports and literature review

Thrombotic thrombocytopenic purpura (TTP) is a haematological disorder which affects the arterioles and capillaries of multiple organs. We reported three cases of TTP successfully treated with low-dosage rituximab combined with plasmpheresis. All three cases were diagnosed according to the diagnostic criteria of TTP. A weekly doses of 100 mg rituximab was applied for four weeks of presentation (on day 1, day 8, day 15 and day 22) as a salvage treatment for relapsing/refractory disease in two cases and as a first-line treatment in one case. Resolution of clinical symptoms and hematological abnormalities occurred as early as the second dose, and after the completion of treatment, all three patients achieved complete response. They were currently free from relapse and the duration of complete response was 5-27 months. During the treatment course, all three patients were given with plasmapheresis in different times. The recommended quantity of plasmapheresis was 40 ml/kg once a day, and the plasmapheresis was stopped when platelet rose to 150×109/L, lasting 2 days. This report indicates that, rituximab exhibits short and long-term favorable effects for the treatment of TTP, and its combination with plasmapheresis may positivity support early salvage therapy in both acute/refractory and relapsing cases.