TY - JOUR
T1 - Rapid and complete resolution of chemotherapy-induced thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS) with rituximab
AU - Gourley, Brett L.
AU - Mesa, Hector
AU - Gupta, Pankaj
N1 - Copyright:
Copyright 2010 Elsevier B.V., All rights reserved.
PY - 2010/4
Y1 - 2010/4
N2 - Purpose: Gemcitabine-induced thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS) is a well described, albeit rare, complication, which is associated with a high morbidity and mortality. Treatment with standard TTP/HUS therapies such as plasma exchange, and cessation of gemcitabine is often unsuccessful. The purpose of this report is to describe the successful treatment of gemcitabine-induced TTP/HUS with rituximab, a CD20 monoclonal antibody that has been used for the treatment of refractory idiopathic TTP/HUS. Methods: We describe the clinical course and follow-up of a patient who developed gemcitabine-induced TTP/HUS, did not respond to cessation of gemcitabine, administration of plasma exchanges, and intravenous glucocorticoids, but responded to rituximab. Results: TTP/HUS responded rapidly and resolved completely with two courses (8 doses) of intravenous rituximab. In three of four reported cases (including the current report), rituximab was rapidly effective in resolving chemotherapy-induced TTP/HUS that was refractory to plasma exchanges and glucocorticoids. Conclusions: Rituximab may be indicated for early treatment of chemotherapy-induced TTP/HUS, particularly when plasma exchange is not rapidly effective.
AB - Purpose: Gemcitabine-induced thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS) is a well described, albeit rare, complication, which is associated with a high morbidity and mortality. Treatment with standard TTP/HUS therapies such as plasma exchange, and cessation of gemcitabine is often unsuccessful. The purpose of this report is to describe the successful treatment of gemcitabine-induced TTP/HUS with rituximab, a CD20 monoclonal antibody that has been used for the treatment of refractory idiopathic TTP/HUS. Methods: We describe the clinical course and follow-up of a patient who developed gemcitabine-induced TTP/HUS, did not respond to cessation of gemcitabine, administration of plasma exchanges, and intravenous glucocorticoids, but responded to rituximab. Results: TTP/HUS responded rapidly and resolved completely with two courses (8 doses) of intravenous rituximab. In three of four reported cases (including the current report), rituximab was rapidly effective in resolving chemotherapy-induced TTP/HUS that was refractory to plasma exchanges and glucocorticoids. Conclusions: Rituximab may be indicated for early treatment of chemotherapy-induced TTP/HUS, particularly when plasma exchange is not rapidly effective.
KW - ADAMTS-13 protein, human
KW - Gemcitabine
KW - Non-small cell lung carcinoma
KW - Rituximab
KW - Thrombotic thrombocytopenic purpura
UR - http://www.scopus.com/inward/record.url?scp=77649186197&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77649186197&partnerID=8YFLogxK
U2 - 10.1007/s00280-010-1258-4
DO - 10.1007/s00280-010-1258-4
M3 - Article
C2 - 20119714
AN - SCOPUS:77649186197
SN - 0344-5704
VL - 65
SP - 1001
EP - 1004
JO - Cancer chemotherapy and pharmacology
JF - Cancer chemotherapy and pharmacology
IS - 5
ER -