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Prompt response to high-dose intravenous immunoglobulins given as first-line therapy in post-transplant thrombotic thrombocytopenic purpura

Bone Marrow Transplantation volume 25, pages 1217–1218 (2000)Cite this article

Milone and co-workers in November 1998, reported on a case of post-transplant thrombotic thrombocytopenic purpura (post-BMT-TTP) cured by multiple plasmaphereses (PP).1 There are several reports that PP is the first-line therapy for patients with de novo TTP2 while response is poor in post-BMT-TTP.34 Milone and co-workers described a case of CML who developed a post-BMT-TTP on day +50; the patient underwent 19 PP up on day +70 but a complete clinical response was seen only on day +250. We hypothesize that spontaneous recovery of the disease occurred.

We observed a prompt response to high-dose immunoglobulins (HD-IG) in a 28-year-old man affected with ALL in first CR who underwent an unrelated BMT after a standard conditioning regimen with cyclophosphamide (120 mg/kg over 2 days i.v.) and TBI (12 Gy in six doses over 3 days); cyclosporin A (CsA) and methotrexate were given as GVHD prophylaxis: CsA (3 mg/kg) was given as a 12 h i.v. infusion from day −1 until the patient started eating. Then 6 mg/kg/day was given orally in two divided doses. Methotrexate was administered at the dose of 15 mg/m2 on day +1 and then on day +3, +6, +11 at the dose of 10 mg/m2 intravenously. Full graft take, defined as the second of 3 consecutive days with PMN >0.5 × 109/l and platelets >25 × 109/l, was documented on day +17; the patient was discharged on day +22 without evidence of acute GVHD.

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  1. Centro Trapianti di Midollo Osseo, Istituto di Ematologia, IRCCS Policlinico S Matteo, Pavia, 27100, Italy

    EP Alessandrino, G Martinelli, A Canevari, P Bernasconi, D Caldera, A Colombo & C Bernasconi

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  1. EP Alessandrino
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  2. G Martinelli
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  3. A Canevari
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  4. P Bernasconi
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  6. A Colombo
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  7. C Bernasconi
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Alessandrino, E., Martinelli, G., Canevari, A. et al. Prompt response to high-dose intravenous immunoglobulins given as first-line therapy in post-transplant thrombotic thrombocytopenic purpura. Bone Marrow Transplant 25, 1217–1218 (2000). https://doi.org/10.1038/sj.bmt.1702441

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