Ofatumumab for acute treatment and prophylaxis of a patient with multiple relapses of acquired thrombotic thrombocytopenic purpura

  • Hanny Al-Samkari
  • Rachael F. Grace
  • Jean M. Connors
Article
  • 55 Downloads

Abstract

Acquired thrombotic thrombocytopenic purpura (TTP) is an autoimmune disorder resulting in potentially life-threating systemic thrombotic microangiopathy due to production of antibodies directed against the von Willebrand factor-cleaving protease ADAMTS13. Typically managed with plasma exchange, glucocorticoids, and the first-generation anti-CD20 monoclonal antibody rituximab, patients with multiple relapses or refractory disease present unique management challenges. We describe a case of a young woman with multiple relapses of TTP despite standard therapy who was treated with ofatumumab, a second-generation anti-CD20 monoclonal antibody, after developing a severe hypersensitivity reaction to rituximab precluding its use. Ofatumumab was effective for the treatment of an acute relapse of TTP in combination with plasmapheresis and as a single-agent for prophylaxis. The patient has had no evidence of relapse 2 years after completion of acute treatment and 1 year after completing prophylactic therapy. Hypersensitivity to ofatumumab did not develop.

Keywords

Thrombotic thrombocytopenic purpura Ofatumumab Drug hypersensitivity Rituximab Prophylaxis 

Notes

Author contributions

HAS collected the data, analyzed and interpreted the data, and wrote/revised the manuscript; RF Grace revised the manuscript; JM Connors designed the report and critically revised the manuscript.

Compliance with ethical standards

Conflict of interest

Al-Samkari, H: Consultancy (Agios Pharmaceuticals); Grace, R: Research Funding, Consultancy, Scientific Advisory Board (Agios Pharmaceuticals); Connors, JM: (Boehringer Ingelheim: Scientific Advisory Board; Bristol-Myers Squibb: Scientific Advisory Board, Consultant, Independent Review Committee; Unum Therapeutics: Data Safety Monitoring Board).

Research involving human and animal participants

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Center for HematologyMassachusetts General Hospital Cancer CenterBostonUSA
  2. 2.Dana-Farber/Boston Children’s Cancer and Blood Disorders CenterBostonUSA
  3. 3.Division of HematologyBrigham and Women’s HospitalBostonUSA

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