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Case Report

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Korean J Hematol 2011; 46(1):

Published online March 31, 2011

https://doi.org/10.5045/kjh.2011.46.1.45

© The Korean Society of Hematology

Slow, but complete, resolution of mitomycin-induced refractory thrombotic thrombocytopenic purpura after rituximab treatment

Mi Jin Hong1, Hong Ghi Lee1*, Mina Hur2, Sung Yong Kim1, Yo Han Cho1, and So Young Yoon1

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1Division of Hematology-Oncology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.

2Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea.

Correspondence to : Correspondence to Hong Ghi Lee, M.D., Ph.D. Division of Hematology-Oncology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 4-12, Hwayang-dong, Gwangjin-gu, Seoul 143-729, Korea. Tel: +82-2-2030-7538, Fax: +82-2-2030-7748, mlee@kuh.ac.kr

Received: November 16, 2010; Revised: November 16, 2010; Accepted: January 26, 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Thrombotic thrombocytopenic purpura (TTP) is a critical complication of treatment with mitomycin C. We retrospectively describe the case of a patient with progressive renal cell carcinoma and mitomycin-induced TTP refractory to plasma exchange and glucocorticoids; we describe the clinical course, successful management of TTP with rituximab, and follow-up of this case. Mitomycin-induced TTP resolved completely by a total of 4 infusions of rituximab 375 mg/m2 on a weekly basis, and it took up to 12 months to obtain a platelet count of >100,000/µL. Rituximab is indicated for the treatment of mitomycin-induced TTP refractory to plasma exchange and glucocorticoids, and it could improve the patient's quality of life despite the presence of underlying malignancy.

Keywords Thrombotic thrombocytopenic purpura, Rituximab, Mitomycin, Plasma exchange

Article

Case Report

Korean J Hematol 2011; 46(1): 45-48

Published online March 31, 2011 https://doi.org/10.5045/kjh.2011.46.1.45

Copyright © The Korean Society of Hematology.

Slow, but complete, resolution of mitomycin-induced refractory thrombotic thrombocytopenic purpura after rituximab treatment

Mi Jin Hong1, Hong Ghi Lee1*, Mina Hur2, Sung Yong Kim1, Yo Han Cho1, and So Young Yoon1

1Division of Hematology-Oncology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.

2Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea.

Correspondence to: Correspondence to Hong Ghi Lee, M.D., Ph.D. Division of Hematology-Oncology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 4-12, Hwayang-dong, Gwangjin-gu, Seoul 143-729, Korea. Tel: +82-2-2030-7538, Fax: +82-2-2030-7748, mlee@kuh.ac.kr

Received: November 16, 2010; Revised: November 16, 2010; Accepted: January 26, 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Thrombotic thrombocytopenic purpura (TTP) is a critical complication of treatment with mitomycin C. We retrospectively describe the case of a patient with progressive renal cell carcinoma and mitomycin-induced TTP refractory to plasma exchange and glucocorticoids; we describe the clinical course, successful management of TTP with rituximab, and follow-up of this case. Mitomycin-induced TTP resolved completely by a total of 4 infusions of rituximab 375 mg/m2 on a weekly basis, and it took up to 12 months to obtain a platelet count of >100,000/µL. Rituximab is indicated for the treatment of mitomycin-induced TTP refractory to plasma exchange and glucocorticoids, and it could improve the patient's quality of life despite the presence of underlying malignancy.

Keywords: Thrombotic thrombocytopenic purpura, Rituximab, Mitomycin, Plasma exchange

Fig 1.

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Figure 1.

Peripheral blood smear (Wright stain, ×1,000) showing schistocytes and spherocytes.

Blood Research 2011; 46: 45-48https://doi.org/10.5045/kjh.2011.46.1.45

Fig 2.

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Figure 2.

Change of platelet and schistocyte count during the treatment period.

Blood Research 2011; 46: 45-48https://doi.org/10.5045/kjh.2011.46.1.45
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