Thrombotic thrombocytopenic purpura resistant to plasma-exchange: salvage treatment with high-dose IgG or vincristine. Italian Cooperative Group for TTP.
Even though plasma-exchange (PE), either alone or combined with cortisone or platelet anti-aggregating substances is the treatment of choice for TTP, 10-15% of patients is resistant to treatment. Since immunoglobulin (IgG) infusion was reported to cure the clinical symptoms of PE-resistant TTP, and vincristine (VCR) has been recently successful in treating TTP, we reviewed the results obtained with both drugs in 20 PE-resistant patients. Of 12 patients receiving IgG and 8 receiving VCR, 3 (25%) and 4 (50%), respectively, achieved complete remission. Even though no conclusions can be drawn from such results, if complete remission can be achieved in a however small number of PE-resistant patients, the use of these drugs is suggested as a salvage treatment for TTP.
Department Internal Medicine, Pavia University, San Matteo Hospital, Italy.
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D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D011697:Purpura, Thrombotic Thrombocytopenic / Q000628:therapy*; D016879:Salvage Therapy; D014750:Vincristine / Q000008:administration & dosage*
D007074:Immunoglobulin G; D014750:Vincristine