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Treatment with plasma exchange (PEX) and steroids has greatly improved the overall prognosis of idiopathic thrombotic thrombocytopenic purpura (TTP), but life-threatening relapses occur in 30% to 50% of patients. The disease mechanism in many patients seems to be antibody-mediated depletion of von Willebrand factor–cleaving protease ADAMTS 13. Anecdotal evidence suggests that rituximab — an anti-CD19 and 20 monoclonal antibody — ameliorates TTP.
To determine the safety and efficacy of rituximab in patients with TTP, investigators in the U.K. conducted a phase II, nonrandomized study that compared outcomes between 40 patients with acute idiopathic disease who received rituximab (375 mg/m2 weekly for 4 weeks) plus standard therapy (PEX and ste…