Low-dose rituximab for the treatment of acute thrombotic thrombocytopenic purpura: report of four cases

Hematology. 2013 Jul;18(4):233-6. doi: 10.1179/1607845412Y.0000000073. Epub 2013 Feb 20.


Objective and importance: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder that needs prompt diagnosis and treatment. Front-line therapy consists of plasma exchange (PEx) and steroids, but, in some instances, this is not enough to achieve a complete and sustained response.

Clinical presentation: We report four cases of TTP treated with low-dose rituximab, PEx, and a short course of steroids with an excellent outcome. Three of the patients had primary TTP and another presented an underlying human immunodeficiency virus infection.

Intervention: Rituximab, 100 mg intravenously, was initiated on days 2-8 from the start of PEx as first-line therapy in three cases and as salvage therapy for relapsing disease in one. The number of PEx needed ranged from 5 to 12 sessions. All patients achieved complete remission and are currently asymptomatic, with complete response duration of 8-22 months.

Conclusion: Treatment of TTP with low-dose rituximab, along with PEx and steroids, seems to be as effective as the standard dose of monoclonal antibody.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Antibodies, Monoclonal, Murine-Derived / administration & dosage*
  • Antineoplastic Agents / administration & dosage
  • Combined Modality Therapy
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Plasma Exchange*
  • Purpura, Thrombotic Thrombocytopenic / blood
  • Purpura, Thrombotic Thrombocytopenic / drug therapy
  • Purpura, Thrombotic Thrombocytopenic / therapy*
  • Rituximab
  • Steroids / administration & dosage*


  • Antibodies, Monoclonal, Murine-Derived
  • Antineoplastic Agents
  • Steroids
  • Rituximab