RITUXIMAB THERAPY AS PROPHYLAXIS AGAINST THROMBOTIC THROMBOCYTOPENIC PURPURA: COMPARISON OF STANDARD AND REDUCED DOSE REGIMENS
(Abstract release date: 05/19/16)
EHA Library. Westwood J. 06/09/16; 132968; E1419
Dr. John-Paul Westwood
Contributions
Contributions
Abstract
Abstract: E1419
Type: Eposter Presentation
Background
Acute antibody-mediated thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy with high morbidity and mortality. Rituximab is highly effective when given as prophylaxis in patients at high risk of acute TTP relapse, but the ideal dosing regimen is unknown.
Aims
A retrospective cohort study across two centres was performed to compare outcomes between TTP patients given rituximab prophylaxis at standard dose (375mg/m2) vs reduced dose (200mg), weekly for 4 weeks.
Methods
Patients had all previously had at least one acute TTP episode, and were deemed at high risk of TTP relapse based on ADAMTS13 activity dropping to ≤15%, having previously been documented in the normal range. Outcome measures included normalisation of ADAMTS13, subsequent relapse rate. Comparison was made of time to re-treatment for patients given standard dose vs reduced dose rituximab.
Results
Rituximab was given in 51 patient episodes, to 32 patients (24F, 8M); in 19 episodes (14 patients) this was re-treatment where patients had received rituximab prophylaxis on at least one prior occasion. In 47/51 (92%) episodes, patients had a median pre-prophylaxis reduction in ADAMTS13 level of ≤15%. Patients received standard dose rituximab in 24 episodes and reduced dose in 27 episodes. Normalisation of ADAMTS13 occurred in 48/51 (94%) patients. Over a median follow up of 14.5 months (range 9-133 months), there were only 2 subacute relapses, both occurring in the reduced dose group. Of the 29 patients requiring re-treatment, 12/29 (41.4%) had received standard dose, and 17/29 (58.6%) reduced dose, at a median 22.5 months (range 10-112 months) in the standard dose group, and 12 months (range 9-33 months) in the reduced dose group, p=0.1351.
Conclusion
Rituximab therapy is effective as prophylaxis normalising ADAMTS13 and preventing acute TTP relapses in patients with immune TTP. Standard dose rituximab prophylaxis may be associated with longer treatment free survival than reduced dose.
Session topic: E-poster
Keyword(s): Rituximab, TTP
Type: Eposter Presentation
Background
Acute antibody-mediated thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy with high morbidity and mortality. Rituximab is highly effective when given as prophylaxis in patients at high risk of acute TTP relapse, but the ideal dosing regimen is unknown.
Aims
A retrospective cohort study across two centres was performed to compare outcomes between TTP patients given rituximab prophylaxis at standard dose (375mg/m2) vs reduced dose (200mg), weekly for 4 weeks.
Methods
Patients had all previously had at least one acute TTP episode, and were deemed at high risk of TTP relapse based on ADAMTS13 activity dropping to ≤15%, having previously been documented in the normal range. Outcome measures included normalisation of ADAMTS13, subsequent relapse rate. Comparison was made of time to re-treatment for patients given standard dose vs reduced dose rituximab.
Results
Rituximab was given in 51 patient episodes, to 32 patients (24F, 8M); in 19 episodes (14 patients) this was re-treatment where patients had received rituximab prophylaxis on at least one prior occasion. In 47/51 (92%) episodes, patients had a median pre-prophylaxis reduction in ADAMTS13 level of ≤15%. Patients received standard dose rituximab in 24 episodes and reduced dose in 27 episodes. Normalisation of ADAMTS13 occurred in 48/51 (94%) patients. Over a median follow up of 14.5 months (range 9-133 months), there were only 2 subacute relapses, both occurring in the reduced dose group. Of the 29 patients requiring re-treatment, 12/29 (41.4%) had received standard dose, and 17/29 (58.6%) reduced dose, at a median 22.5 months (range 10-112 months) in the standard dose group, and 12 months (range 9-33 months) in the reduced dose group, p=0.1351.
Conclusion
Rituximab therapy is effective as prophylaxis normalising ADAMTS13 and preventing acute TTP relapses in patients with immune TTP. Standard dose rituximab prophylaxis may be associated with longer treatment free survival than reduced dose.
Session topic: E-poster
Keyword(s): Rituximab, TTP
Abstract: E1419
Type: Eposter Presentation
Background
Acute antibody-mediated thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy with high morbidity and mortality. Rituximab is highly effective when given as prophylaxis in patients at high risk of acute TTP relapse, but the ideal dosing regimen is unknown.
Aims
A retrospective cohort study across two centres was performed to compare outcomes between TTP patients given rituximab prophylaxis at standard dose (375mg/m2) vs reduced dose (200mg), weekly for 4 weeks.
Methods
Patients had all previously had at least one acute TTP episode, and were deemed at high risk of TTP relapse based on ADAMTS13 activity dropping to ≤15%, having previously been documented in the normal range. Outcome measures included normalisation of ADAMTS13, subsequent relapse rate. Comparison was made of time to re-treatment for patients given standard dose vs reduced dose rituximab.
Results
Rituximab was given in 51 patient episodes, to 32 patients (24F, 8M); in 19 episodes (14 patients) this was re-treatment where patients had received rituximab prophylaxis on at least one prior occasion. In 47/51 (92%) episodes, patients had a median pre-prophylaxis reduction in ADAMTS13 level of ≤15%. Patients received standard dose rituximab in 24 episodes and reduced dose in 27 episodes. Normalisation of ADAMTS13 occurred in 48/51 (94%) patients. Over a median follow up of 14.5 months (range 9-133 months), there were only 2 subacute relapses, both occurring in the reduced dose group. Of the 29 patients requiring re-treatment, 12/29 (41.4%) had received standard dose, and 17/29 (58.6%) reduced dose, at a median 22.5 months (range 10-112 months) in the standard dose group, and 12 months (range 9-33 months) in the reduced dose group, p=0.1351.
Conclusion
Rituximab therapy is effective as prophylaxis normalising ADAMTS13 and preventing acute TTP relapses in patients with immune TTP. Standard dose rituximab prophylaxis may be associated with longer treatment free survival than reduced dose.
Session topic: E-poster
Keyword(s): Rituximab, TTP
Type: Eposter Presentation
Background
Acute antibody-mediated thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy with high morbidity and mortality. Rituximab is highly effective when given as prophylaxis in patients at high risk of acute TTP relapse, but the ideal dosing regimen is unknown.
Aims
A retrospective cohort study across two centres was performed to compare outcomes between TTP patients given rituximab prophylaxis at standard dose (375mg/m2) vs reduced dose (200mg), weekly for 4 weeks.
Methods
Patients had all previously had at least one acute TTP episode, and were deemed at high risk of TTP relapse based on ADAMTS13 activity dropping to ≤15%, having previously been documented in the normal range. Outcome measures included normalisation of ADAMTS13, subsequent relapse rate. Comparison was made of time to re-treatment for patients given standard dose vs reduced dose rituximab.
Results
Rituximab was given in 51 patient episodes, to 32 patients (24F, 8M); in 19 episodes (14 patients) this was re-treatment where patients had received rituximab prophylaxis on at least one prior occasion. In 47/51 (92%) episodes, patients had a median pre-prophylaxis reduction in ADAMTS13 level of ≤15%. Patients received standard dose rituximab in 24 episodes and reduced dose in 27 episodes. Normalisation of ADAMTS13 occurred in 48/51 (94%) patients. Over a median follow up of 14.5 months (range 9-133 months), there were only 2 subacute relapses, both occurring in the reduced dose group. Of the 29 patients requiring re-treatment, 12/29 (41.4%) had received standard dose, and 17/29 (58.6%) reduced dose, at a median 22.5 months (range 10-112 months) in the standard dose group, and 12 months (range 9-33 months) in the reduced dose group, p=0.1351.
Conclusion
Rituximab therapy is effective as prophylaxis normalising ADAMTS13 and preventing acute TTP relapses in patients with immune TTP. Standard dose rituximab prophylaxis may be associated with longer treatment free survival than reduced dose.
Session topic: E-poster
Keyword(s): Rituximab, TTP
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