title: Type of plasma preparation used for plasma exchange and clinical outcome of adult patients with acquired idiopathic thrombotic thrombocytopenic purpura: a French retrospective multicenter cohort study.
abstract: BACKGROUND
  Plasma exchange (PE) is the first-line therapy of acquired thrombotic thrombocytopenic purpura (TTP). Several plasma preparations have been available; their equivalence in terms of outcome remains uncertain.
  
  
  METHODS
  We performed a retrospective analysis of the cases prospectively reported from 2005 to 2010 to the national registry established by the thrombotic microangiopathies French reference center. We analyzed 108 initial episodes of acquired idiopathic TTP in adults treated with PE, 81 with solvent/detergent (S/D) plasma, and 27 with quarantine fresh-frozen plasma (qFFP). The primary endpoint was the time to platelet (PLT) count recovery.
  
  
  RESULTS
  Time to PLT count recovery was not significantly different with S/D plasma versus qFFP (median, 15 days vs. 19 days, respectively; p = 0.126). Complete remission rates, exacerbations, and survival were comparable. By multivariate competitive risk (Fine-Gray) analysis, the only significant association with a shorter time to PLT count recovery was the absence of additional treatment (hazard ratio, 2.06; 95% confidence interval [CI], 1.39-3.05; p < 0.001). There was a significant interaction between type of plasma and age, and for patients less than 40 years old, the use of S/D plasma was associated with a shorter time to PLT count recovery versus qFFP (median, 13 [95% CI, 9-16] days vs. 20 [95% CI, 16-64] days, respectively; p = 0.004).
  
  
  CONCLUSIONS
  The outcomes of acquired TTP treated with S/D plasma or qFFP seem similar and therefore both preparations can be used safely for PE in this indication. The faster response of S/D plasma observed in younger patients warrants confirmation in prospective studies.
authors.affiliation: EFS Lorraine Champagne, Nancy, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Toussaint-Hacquard
authors.affiliation: Centre National de Référence des Microangiopathies Thrombotiques.|Service d'Hématologie Hôpital St Antoine APHP Université Pierre et Marie Curie (Université Paris 6), Paris, France.|Unité Inserm U1009, Institut Gustave Roussy, Villejuif, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Coppo
authors.affiliation: Inserm CIC EC-CIC 1433, Université Lorraine, Nancy, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Soudant
authors.affiliation: EFS Lorraine Champagne, Nancy, France.
authors.forename: Lysiane
authors.initials: L
authors.lastname: Chevreux
authors.affiliation: EFS Lorraine Champagne, Nancy, France.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Mathieu-Nafissi
authors.affiliation: EFS Lorraine Champagne, Nancy, France.|Service d'Hématologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lecompte
authors.affiliation: EFS Lorraine Champagne, Nancy, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Gross
authors.affiliation: Inserm CIC EC-CIC 1433, Université Lorraine, Nancy, France.
authors.forename: Francis
authors.initials: F
authors.lastname: Guillemin
authors.affiliation: EFS Pays de la Loire, Nantes, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Schneider
mesh_terms: D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma; D010951:Plasma Exchange; D010976:Platelet Count; D011697:Purpura, Thrombotic Thrombocytopenic / Q000097:blood / Q000401:mortality / Q000628:therapy; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate