Ofatumumab for acute treatment and prophylaxis of a patient with multiple relapses of acquired thrombotic thrombocytopenic purpura
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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.
KeywordsThrombotic thrombocytopenic purpura Ofatumumab Drug hypersensitivity Rituximab Prophylaxis
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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