Therapeutic plasma exchange taper does not decrease exacerbations in immune thrombotic thrombocytopenic purpura patients

Authors

Jay S. Raval, Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USADepartment of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
Marshall A. Mazepa, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
Marian A. Rollins-Raval, Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
Raj S. Kasthuri, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
Yara A. Park, Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA

Document Type

Article

Publication Date

8-1-2020

Abstract

BACKGROUND: Despite rapid and intensive treatments with therapeutic plasma exchange (TPE) and immunosuppression, immune thrombotic thrombocytopenic purpura (TTP) patients are at risk of disease exacerbation, i.e., early recurrence of TTP within 30 days of achieving treatment response. TPE taper, a practice of performing additional TPE procedures after achieving treatment response, is commonly performed for decreasing exacerbations, although no evidence supports this practice.

STUDY DESIGN AND METHODS: In this prospective observational investigation over four years, our center switched its standard of care for treating all TTP patients from not performing TPE taper after achieving treatment response (i.e., no-taper cohort) to performance of TPE taper (i.e., yes-taper cohort) to characterize impacts on exacerbations. Continuous and categorical data were analyzed by Mann-Whitney, Fisher's exact, and log-rank tests; significance was defined as p < 0.05.

RESULTS: The two cohorts were well matched and had no significant differences in demographics, presentation laboratory values, or TTP history (p > 0.05 for all). The yes-taper cohort of 26 patients with 29 consecutive episodes did not have a significantly different exacerbation rate from the no-taper cohort of 24 patients with 27 consecutive episodes (exacerbation rates of 37.9% vs. 33.3%, respectively; p = 0.78); however, treatment-related complications directly attributed to the TPE procedures, blood products, or central venous catheters were significantly greater in the yes-taper cohort (nine vs. one events, respectively; p = 0.01).

CONCLUSION: Since TPE taper did not reduce exacerbations in our TTP patients, we no longer advocate for TPE taper and have reverted to our original standard of care.

Recommended Citation

Raval JS, Mazepa MA, Rollins-Raval MA, Kasthuri RS, Park YA. Therapeutic plasma exchange taper does not decrease exacerbations in immune thrombotic thrombocytopenic purpura patients. Transfusion. 2020 Aug;60(8):1676-1680. doi: 10.1111/trf.15901. Epub 2020 Jul 21. PMID: 32696551.