nach oben

Clinical Rheumatology

Erschienen in:

30.08.2017 | Original Article

TMA secondary to SLE: rituximab improves overall but not renal survival

verfasst von: Fangfang Sun, Xiaodong Wang, Wanlong Wu, Kaiwen Wang, Zhiwei Chen, Ting Li, Shuang Ye

Erschienen in: Clinical Rheumatology | Ausgabe 1/2018

Einloggen, um Zugang zu erhalten

Abstract

Thrombotic microangiopathy (TMA) includes a series of life-threatening disorders. Systemic lupus erythematosus (SLE) is one of the most common acquired causes. To identify predictors of prognosis in patients with TMA secondary to SLE, we conducted a single-center historical study. From January 2013 to June 2016, of 2182 SLE hospitalized patients in the Ren Ji Hospital, a total of 21 consecutive patients with TMA secondary to SLE were identified. The 90-day short-term mortality was 33.3%. The kidney involvement (66.7%) was associated with poor prognosis, while the administration of rituximab (n = 13) was an independent protective factor according to logistic regression analysis. Compared to conventional treatment, i.e., plasma exchange, high-dose glucocorticoids, and intravenous immunoglobulin, the overall survival is significantly higher among patients receiving rituximab add-on (92.2 vs 33.3%, p = 0.0173); however, five out of seven patients with renal involvement in the rituximab group were eventually hemodialysis dependent. Our data indicated that add-on rituximab in the background of conventional therapy may improve the overall but not the renal survival in SLE-TMA patients.

George JN, Nester CM (2014) Syndromes of thrombotic microangiopathy. N Engl J Med 371(7):654–666. https://doi.org/10.1056/NEJMra1312353 CrossRefPubMed

Blombery P, Kivivali L, Pepperell D, McQuilten Z, Engelbrecht S, Polizzotto MN, Phillips LE, Wood E, Cohney S, committee TTPrs (2016) Diagnosis and management of thrombotic thrombocytopenic purpura (TTP) in Australia: findings from the first 5 years of the Australian TTP/thrombotic microangiopathy registry. Intern Med J 46(1):71–79. https://doi.org/10.1111/imj.12935 CrossRefPubMed

Mehmood T, Taylor M, Winters JL (2016) Management of thrombotic microangiopathic hemolytic anemias with therapeutic plasma exchange: when it works and when it does not. Hematol Oncol Clin North Am 30(3):679–694. https://doi.org/10.1016/j.hoc.2016.01.009 CrossRefPubMed

Schneider M (2007) Thrombotic microangiopathy (TTP and HUS): advances in differentiation and diagnosis. Clin Lab Sci 20(4):216–220PubMed

Forzley BR, Clark WF (2009) TTP/HUS and prognosis: the syndrome and the disease(s). Kidney Int Suppl 112:S59–S61. https://doi.org/10.1038/ki.2008.623 CrossRef

von Baeyer H (2002) Plasmapheresis in thrombotic microangiopathy-associated syndromes: review of outcome data derived from clinical trials and open studies. Ther Apher 6(4):320–328CrossRef

Peyvandi F, Scully M, Kremer Hovinga JA, Cataland S, Knobl P, Wu H, Artoni A, Westwood JP, Mansouri Taleghani M, Jilma B, Callewaert F, Ulrichts H, Duby C, Tersago D, Investigators T (2016) Caplacizumab for acquired thrombotic thrombocytopenic purpura. N Engl J Med 374(6):511–522. https://doi.org/10.1056/NEJMoa1505533 CrossRefPubMed

Coppo P (2012) Thrombotic microangiopathies: from empiricism to targeted therapies. Presse Med 41(3 Pt 2):e101–e104. https://doi.org/10.1016/j.lpm.2011.10.023 CrossRefPubMed

Wieland I, Kentouche K, Jentzsch M, Lothschutz D, Graf N, Sykora KW (2015) Long-term remission of recurrent thrombotic thrombocytopenic purpura (TTP) after rituximab in children and young adults. Pediatr Blood Cancer 62(5):823–829. https://doi.org/10.1002/pbc.25398 CrossRefPubMed

10.

Miyakawa Y (2014) Recent progress of diagnosis and treatment for immune-mediated hematological diseases. Topics: IV. Recent topics; 2. Rituximab for ITP and TTP. Nihon Naika Gakkai Zasshi 103(7):1654–1659CrossRefPubMed

11.

Scully M (2012) Rituximab in the treatment of TTP. Hematology 17(Suppl 1):S22–S24. https://doi.org/10.1179/102453312X13336169155178 PubMed

12.

Kafle P, Malakoff GL (2012) Coexistence of systemic lupus erythematosus and thrombotic thrombocytopenic purpura: a case report. Tenn Med 105(5):37–38PubMed

13.

Niaz FA, Aleem A (2010) Response to rituximab in a refractory case of thrombotic thrombocytopenic purpura associated with systemic lupus erythematosus. Saudi J Kidney Dis Transpl 21(1):109–112PubMed

14.

Kamiya K, Kurasawa K, Arai S, Maezawa R, Hanaoka R, Kumano K, Fukuda T (2010) Rituximab was effective on refractory thrombotic thrombocytopenic purpura but induced a flare of hemophagocytic syndrome in a patient with systemic lupus erythematosus. Mod Rheumatol 20(1):81–85. https://doi.org/10.1007/s10165-009-0231-8 CrossRefPubMed

15.

Miyamura T, Watanabe H, Takahama S, Sonomoto K, Nakamura M, Ando H, Minami R, Yamamoto M, Suematsu E (2008) Thrombotic thrombocytopenic purpura in patients with systemic lupus erythematosus. Nihon Rinsho Men'eki Gakkai Kaishi 31(3):159–165CrossRefPubMed

16.

Hundae A, Peskoe S, Grimsley E, Patel S (2008) Rituximab therapy for refractory thrombotic thrombocytopenic purpura and autoimmune-mediated thrombocytopenia in systemic lupus erythematosus. South Med J 101(9):943–944. https://doi.org/10.1097/SMJ.0b013e3181809ebd CrossRefPubMed

17.

Shah AA, Higgins JP, Chakravarty EF (2007) Thrombotic microangiopathic hemolytic anemia in a patient with SLE: diagnostic difficulties. Nat Clin Pract Rheumatol 3(6):357–362. https://doi.org/10.1038/ncprheum0511 CrossRefPubMed

18.

Chen MH, Chen MH, Chen WS, Mu-Hsin Chang P, Lee HT, Lin HY, Huang DF (2011) Thrombotic microangiopathy in systemic lupus erythematosus: a cohort study in North Taiwan. Rheumatology 50(4):768–775. https://doi.org/10.1093/rheumatology/keq311 CrossRefPubMed

19.

Lansigan F, Isufi I, Tagoe CE (2011) Microangiopathic haemolytic anaemia resembling thrombotic thrombocytopenic purpura in systemic lupus erythematosus: the role of ADAMTS13. Rheumatology 50(5):824–829. https://doi.org/10.1093/rheumatology/keq395 CrossRefPubMed

20.

Letchumanan P, Ng HJ, Lee LH, Thumboo J (2009) A comparison of thrombotic thrombocytopenic purpura in an inception cohort of patients with and without systemic lupus erythematosus. Rheumatology 48(4):399–403. https://doi.org/10.1093/rheumatology/ken510 CrossRefPubMed

21.

Kwok SK, Ju JH, Cho CS, Kim HY, Park SH (2009) Thrombotic thrombocytopenic purpura in systemic lupus erythematosus: risk factors and clinical outcome: a single centre study. Lupus 18(1):16–21. https://doi.org/10.1177/0961203308094360 CrossRefPubMed

22.

Maruoka H, Koga T, Inoue Y, Honda S, Takeo M, Fukuda T, Aizawa H (2007) Recurrent thrombotic thrombocytopenic purpura in a patient with systemic lupus erythematosus. Mod Rheumatol 17(5):426–428. https://doi.org/10.1007/s10165-007-0611-x CrossRefPubMed

23.

Benhamou Y, Paintaud G, Azoulay E, Poullin P, Galicier L, Desvignes C, Baudel JL, Peltier J, Mira JP, Pene F, Presne C, Saheb S, Deligny C, Rousseau A, Feger F, Veyradier A, Coppo P, French Reference Center for Thrombotic M (2016) Efficacy of a rituximab regimen based on B cell depletion in thrombotic thrombocytopenic purpura with suboptimal response to standard treatment: results of a phase II, multicenter non-comparative study. Am J Hematol. https://doi.org/10.1002/ajh.24559

24.

Cuker A (2016) Adjuvant rituximab to prevent TTP relapse. Blood 127(24):2952–2953. https://doi.org/10.1182/blood-2016-04-710475 CrossRefPubMed

25.

Jayabose S, Dunbar J, Nowicki TS, Tugal O, Ozkaynak MF, Sandoval C (2011) Rituximab therapy to prevent relapse in chronic relapsing thrombotic thrombocytopenic purpura (TTP) in a child. Pediatr Hematol Oncol 28(2):167–172. https://doi.org/10.3109/08880011003739414 CrossRefPubMed

26.

Abou-Nassar K, Karsh J, Giulivi A, Allan D (2010) Successful prevention of thrombotic thrombocytopenic purpura (TTP) relapse using monthly prophylactic plasma exchanges throughout pregnancy in a patient with systemic lupus erythematosus and a prior history of refractory TTP and recurrent fetal loss. Transfus Apher Sci 43(1):29–31. https://doi.org/10.1016/j.transci.2010.05.002 CrossRefPubMed

27.

Jin M, Casper TC, Cataland SR, Kennedy MS, Lin S, Li YJ, Wu HM (2008) Relationship between ADAMTS13 activity in clinical remission and the risk of TTP relapse. Br J Haematol 141(5):651–658. https://doi.org/10.1111/j.1365-2141.2008.07107.x CrossRefPubMed

Titel: TMA secondary to SLE: rituximab improves overall but not renal survival
verfasst von: Fangfang Sun
Xiaodong Wang
Wanlong Wu
Kaiwen Wang
Zhiwei Chen
Ting Li
Shuang Ye
Publikationsdatum: 30.08.2017
Verlag: Springer London
Erschienen in: Clinical Rheumatology / Ausgabe 1/2018
Print ISSN: 0770-3198
Elektronische ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-017-3793-4

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

23.04.2024 | Ablationstherapie | Nachrichten

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

TMA secondary to SLE: rituximab improves overall but not renal survival

Abstract

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

Europäische Ernährungsgewohnheiten: Das sind die häufigsten Fehler

Hinter dieser Appendizitis steckte ein Erreger

Demenzkranke durch Antipsychotika vielfach gefährdet

Update Innere Medizin

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2018

A rare case of meningoencephalitis by Listeria monocytogenes in systemic lupus erythematosus: case report and review

The performance of different anti-dsDNA autoantibodies assays in Chinese systemic lupus erythematosus patients

Prevalence of depression and anxiety in rheumatoid arthritis patients and their associations with serum vitamin D level

Increased expression of Bruton’s tyrosine kinase in peripheral blood is associated with lupus nephritis

Sixteen Chinese pediatric brucellosis patients onset of fever in non-epidemic areas and 8 developed with osteoarticular involvement

Metabolic abnormalities in rheumatoid arthritis patients with comorbid diabetes mellitus

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

Europäische Ernährungsgewohnheiten: Das sind die häufigsten Fehler

Hinter dieser Appendizitis steckte ein Erreger

Demenzkranke durch Antipsychotika vielfach gefährdet

Update Innere Medizin