title: Thrombotic thrombocytopenic purpura associated with renal failure after autologous transplantation for multiple myeloma successfully treated with rituximab.
abstract: Thrombotic thrombocytopenic purpura (TTP) is a haematological syndrome characterised by a dramatic onset requiring an urgent treatment with plasma exchange (PE). However, the prognosis is still dismal for PE related complications, a rate of failure and remarkable frequencies of relapse. TTP post transplantation is largely described as an outstanding, unusual complication of allogenic transplantation, but it is rarely mentioned after autologous transplantation. We describe a 62-year-old Caucasian patient who presented with TTP, accompanied by renal failure, after an autologous transplantation for multiple myeloma. PE together with hemodialysis was rapidly initiated but without any benefit. Since empirical administration of Rituximab, anti CD20 monoclonal antibody,was reported to be effective, we administered four courses of Rituximab inducing a complete remission of TTP and subsequently of the renal failure. This response to Rituximab in TTP post transplantation is suggestive of a possible implication of B-lymphocytes in the pathogenesis of TTP and it paves the way for an investigational approach in this settings.
authors.affiliation: Department of Oncology, Institute of Oncology of Southern Switzerland, Bellinzona, Switzerland.
authors.forename: Elisa
authors.initials: E
authors.lastname: Gallerani
authors.forename: Erika
authors.initials: E
authors.lastname: Lerch
authors.forename: Elena
authors.initials: E
authors.lastname: Romagnani
authors.forename: Anastasios
authors.initials: A
authors.lastname: Stathis
authors.forename: Greta
authors.initials: G
authors.lastname: Giardelli
authors.forename: Hugo
authors.initials: H
authors.lastname: Zwhalen
authors.forename: Claudio
authors.initials: C
authors.lastname: Marone
authors.forename: Franco
authors.initials: F
authors.lastname: Cavalli
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000096:biosynthesis; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001792:Blood Platelets / Q000187:drug effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000628:therapy*; D011379:Prognosis; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications* / Q000209:etiology*; D012008:Recurrence; D051437:Renal Insufficiency / Q000150:complications* / Q000209:etiology*; D000069283:Rituximab; D033581:Stem Cell Transplantation / Q000009:adverse effects; D014182:Transplantation, Autologous / Q000009:adverse effects
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000970:Antineoplastic Agents; D000069283:Rituximab