Immune thrombotic thrombocytopenic purpura: Personalized therapy using ADAMTS‐13 activity and autoantibodies

Research and Practice in Thrombosis and Haemostasis

Francesca Palandri¹  Giuseppe Auteri¹  Christian Di Pietro¹  Daniela Bartoletti¹  Michele Cavo¹  Nicola Vianelli¹  Francesca Ricci²  Pier Luigi Tazzari²  Vanda Randi² 

[1] IRCCS Azienda Ospedaliero‐Universitaria di BolognaIstituto di Ematologia “Seràgnoli” Bologna Italy;IRCCS Azienda Ospedaliero‐Universitaria di BolognaU.O. Immunoematologia e Medicina Trasfusionale Bologna Italy;

关键词: ADAMTS‐13;    caplacizumab;    COVID‐19;    rituximab;    thrombotic thrombocytopenic purpura;    TTP;   

DOI  :  10.1002/rth2.12606

来源: DOAJ

【 摘 要 】

Abstract Recently, treatment of immune‐mediated thrombotic thrombocytopenic purpura (ITTP) has changed with the advent of caplacizumab in clinical practice. The International Working Group (IWG) has recently integrated the ADAMTS‐13 activity/autoantibody monitoring in consensus outcome definitions. We report three ITTP cases during the coronavirus disease 2019 pandemic, that received a systematic evaluation of ADAMTS‐13 activity and autoantibodies. We describe how the introduction of caplacizumab and ADAMTS‐13 monitoring could change the management of ITTP patients and discuss whether therapeutic choices should be based on the clinical response alone. ADAMTS‐13 activity/antibodies were assessed every 5 days. Responses were evaluated according to updated IWG outcome definitions. These kinetics, rather than clinical remission, guided the therapy, allowing early and safe caplacizumab discontinuation and sensible administration of rituximab. Caplacizumab was cautiously discontinued after achieving ADAMTS‐13 complete remission. These cases illustrate that prospective ADAMTS‐13 evaluation and use of updated IWG definitions may improve real‐life patients’ management in the caplacizumab era.

【 授权许可】

Unknown