Rapid and complete resolution of chemotherapy-induced thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS) with rituximab.
OBJECTIVE
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.
Gourley
Brett L
BL
Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Mesa
Hector
H
Gupta
Pankaj
P
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D001772:Blood Cell Count; D001792:Blood Platelets / Q000378:metabolism; D003404:Creatinine / Q000378:metabolism; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D006454:Hemoglobins / Q000378:metabolism; D006463:Hemolytic-Uremic Syndrome / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011697:Purpura, Thrombotic Thrombocytopenic / Q000139:chemically induced / Q000188:drug therapy*; D000069283:Rituximab; D000093542:Gemcitabine
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000964:Antimetabolites, Antineoplastic; D006454:Hemoglobins; D003841:Deoxycytidine; D000069283:Rituximab; D003404:Creatinine; D007770:L-Lactate Dehydrogenase; D000093542:Gemcitabine