ABSTRACT
BACKGROUND: Between 30% and 60% of patients with thrombotic thrombocytopenic purpura (TTP) relapse and mortality remains at 15-20%. Limited clinical data suggest that the administration of anti-CD20 antibody (rituximab) may be useful in preventing acute refractory and chronic relapsing TTP. DESIGN AND METHODS: We studied the clinical response to rituximab in 24 adult patients (median age 42 years, range 24-72 years) from 15 Spanish centers with an acute refractory (14 patients) or acute relapsing (10 patients) episode of idiopathic TTP. On admission, every patient received daily plasma exchange (PE). Rituximab was administered at a dose of 375 mg/m(2) weekly for a median of 13 days (range 0-57 days) after starting PE for a median of 4 doses (range 1-8 doses). RESULTS: No severe acute or delayed toxicity was observed in the patients treated with rituximab. Three (12.5%) patients died because of TTP-related causes. The remaining 21 (87.5%) patients achieved complete remission in a median of 21 days (range 2-35 days) after initiating rituximab. After a median follow-up of 30 months (range 7.5-74 months), 18 patients are in remission and 3 patients have relapsed at 7, 29, and 29 months. CONCLUSIONS: Rituximab appears to be a safe, effective therapy and has a high response rate for the treatment of acute refractory or relapsing idiopathic TTP in adult patients.
Subject(s)
Antibodies, Monoclonal, Murine-Derived/therapeutic use , Purpura, Thrombotic Thrombocytopenic/drug therapy , Salvage Therapy/methods , Adult , Aged , Drug Evaluation , Humans , Middle Aged , Plasma Exchange , Purpura, Thrombotic Thrombocytopenic/therapy , Retrospective Studies , Rituximab , Spain , Treatment Outcome , Young AdultABSTRACT
The remission rate with plasma exchange (PE) in thrombotic thrombocytopenic purpura (TTP) exceeds 80%, but the disease relapses in up to 20-30% of the cases. Clinical characteristics and response to treatment of relapsed TTP are not well defined. The objective of the present study was to compare the clinical and biological characteristics at presentation and the response to treatment between de novo and relapsed TTP. For such purpose, a total of 102 episodes of idiopathic TTP (70 de novo and 32 relapses) included in a recent multicentric prospective cohort study were analysed. All patients were homogeneously treated with daily PE and costicosteroids. In comparison with de novo TTP, episodes of relapsed TTP showed a higher Hb level (median, 122 g/l versus 91 g/l, p < 0.001) and lower serum lactate dehydrogenase (2.2- versus 4.5-fold above the upper limit of normality, p < 0.001). Neurological symptoms and fever were less frequently observed in patients with relapsed TTP than in patients with de novo TTP. Patients with relapsed TTP needed fewer PE sessions (five versus ten, p = 0.02) and a smaller volume of plasma (221 ml/kg versus 468 ml/kg, p = 0.004) to achieve remission than those with de novo TTP. There was no significant difference in the rate of recrudescence under treatment, the need of complementary treatments or the frequency of refractoriness to PE therapy. In conclusion, relapsed TTP has a milder clinical profile and responds more easily to PE than de novo TTP.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Plasma Exchange , Purpura, Thrombotic Thrombocytopenic/therapy , Adolescent , Adult , Aged , Cohort Studies , Female , Fever/etiology , Hemoglobins/analysis , Humans , L-Lactate Dehydrogenase/blood , Male , Middle Aged , Nervous System Diseases/etiology , Prospective Studies , Purpura, Thrombotic Thrombocytopenic/complications , Purpura, Thrombotic Thrombocytopenic/pathology , Recurrence , Treatment Outcome , Young AdultSubject(s)
Fetal Blood/cytology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Purpura, Thrombotic Thrombocytopenic/diagnosis , Purpura, Thrombotic Thrombocytopenic/etiology , Stem Cell Transplantation/adverse effects , Adult , Fatal Outcome , Female , Humans , Leukemia, Myeloid, Acute/drug therapy , Leukemia, Myeloid, Acute/therapy , Male , Treatment OutcomeABSTRACT
Mononuclear cell leukapheresis requires good-quality venous access. Catheter placement and removal of the catheter may be associated with life-threatening local or systemic complications. Thus, prompt recognition of these complications and appropriate therapy can be life-saving. We report the case of a young man who presented with an air embolism following removal of a jugular venous catheter after peripheral blood stem cell collection. We have reviewed the signs and symptoms presented by the patient and the methodology used to remove the catheter. Catheter removal requires careful attention in order to avoid potentially serious complications.
Subject(s)
Catheterization, Peripheral , Device Removal , Embolism, Air/drug therapy , Leukapheresis , Pulmonary Embolism/drug therapy , Adult , Catheterization, Peripheral/methods , Device Removal/adverse effects , Device Removal/methods , Embolism, Air/diagnosis , Embolism, Air/etiology , Humans , Jugular Veins , Male , Pulmonary Embolism/diagnosis , Pulmonary Embolism/etiologyABSTRACT
BACKGROUND: Our purpose was to evaluate the results of the promotion of blood donation in patients undergoing stem cell transplantation (SCT) and to compare it with this promotion in remaining in-patients. PATIENTS AND METHODS: The hematologist and the blood bank staff informed the patient undergoing SCT about the need for transfusions. Donors were selected for blood or platelet donation. In remaining in-patients, promotion was performed by the blood bank staff by interviewing patients. RESULTS: Between January 2000 and May 2001, 48 SCT patients were included: 41 (85%) yielded 453 possible donors. Of them, 306 donated blood, 77 platelets and 82 were excluded. The number of donations was 484 (389 whole blood and 105 platelets), and 25% (n = 98) of patients donated blood subsequently. Among in-patients 1,950 interviews were carried out: 533 (27.3%) yielded 901 donors (p < 0.001). Overall, 1,146 blood donations were obtained and 15% (135) of these donors donated blood subsequently (p < 0.001). CONCLUSION: Collaboration of the hematologist in the promotion of blood donation leads to an increase in the rate and frequency of donations.
Subject(s)
Blood Banks/statistics & numerical data , Blood Donors/statistics & numerical data , HumansABSTRACT
FUNDAMENTO: Valorar la promoción de la donación de sangre realizada en el entorno de los pacientes que reciben un trasplante de progenitores hematopoyéticos (TPH) y compararla con la promoción que se realiza en el entorno del resto de pacientes ingresados. PACIENTES Y MÉTODO: El hematólogo y el promotor del Banco de Sangre informaron de la probabilidad de transfusión al paciente candidato a TPH. Se efectuó una selección de los posibles donantes para la donación de sangre total o de plaquetas. En el resto de los pacientes ingresados la promoción se efectuó mediante la visita del promotor al paciente transfundido o con solicitud de transfusión, sin intervención del médico que atendía al paciente. RESULTADOS: Entre enero de 2000 y mayo de 2001 se realizaron 48 visitas a pacientes candidatos a TPH: 41 (85 por ciento) aportaron 453 posibles donantes, 306 donaron sangre, 77 plaquetas y 82 fueron excluidos. Se obtuvieron 484 donaciones, 389 de sangre total y 105 de plaquetas. Un 25 por ciento (98 donantes) volvió a donar espontáneamente. Entre el resto de los pacientes ingresados, durante el año 1998 se realizaron 1.950 entrevistas, consiguiendo colaboración en 533 (27,3 por ciento) de los casos (p < 0,001) con un total de 901 donantes. Se obtuvieron 1.146 donaciones y un 15 por ciento (n = 135) de estos donantes continuaron donando (p < 0,001). CONCLUSIONES: La implicación del hematólogo en la promoción de la donación a partir del entorno de los pacientes ingresados repercute en un aumento de la tasa de donaciones y en la fidelidad de las mismas. (AU)
