Therapeutic Modality of 11 Patients with TTP in a Single Institution in Miyazaki from 2000 to 2011
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概要
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Objective Thrombotic thrombocytopenic purpura (TTP) is a life-threatening generalized disease with pathological features that are termed thrombotic microangiopathies. Since the discovery of the von Willebrand factor-cleaving protease [a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13)], it is widely known that approximately two-thirds of TTP patients have a severe deficiency of ADAMTS13 activity due to gene mutations or acquired autoantibodies to this enzyme. However, the remaining one-third of TTP patients have only moderately reduced or almost normal ADAMTS13 activity. To elucidate the clinical characteristics and outcomes of these two types of TTP, we have retrospectively analyzed the cases of acquired TTP patients treated in a single institution from 2000 to 2011. Methods Our case studies include 11 TTP patients, of which 5 were considered idiopathic and 6 had cases of TTP associated with underlying diseases such as non-Hodgkin lymphoma or connective tissue diseases. Results These patients were treated with a combination therapy of plasma exchange and steroids and with several adjunctive therapeutic regimens including the on-label use of cyclophosphamide and cyclosporine and the off-label use of high-dose steroid or immunoglobulin with rituximab. Splenectomies were not performed. As a result of these treatments, 6 out of the 7 patients with ADAMTS13 activity deficient TTP achieved a complete remission without relapse, but the remaining 4 patients with non-ADAMTS13 activity deficient TTP all died without complete remission. Conclusion We present herein the detailed clinical courses of 11 patients with TTP and address our experiences with the efficacy of various therapeutic regimens. This case-oriented study should be helpful to the physicians who directly care for TTP patients, and may provide a future direction for developing a more efficient treatment modality.
著者
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MAKINO Shigeyoshi
Department of Internal Medicine, Miyazaki Prefectural Hospital
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Yokota-Ikeda Naoko
Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
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Shimao Yoshiya
Department Of Pathology Miyazaki Medical College
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Yoshida Shuro
Department Of Internal Medicine Miyazaki Prefectural Miyazaki Hospital
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Fujimura Yoshihiro
Department Of Blood Transfusion Medicine Nara Medical University
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Ueda Akira
Department Of Applied Mathematics And Physics Faculty Of Engineering Kyoto University
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Sugio Yasuhiro
Department Of Internal Medicine Miyazaki Prefectural Miyazaki Hospital
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Himeji Daisuke
Department Of Internal Medicine Miyazaki Prefectural Miyazaki Hospital
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Uezono Shigehiro
Department Of Internal Medicine Miyazaki Prefectural Miyazaki Hospital
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Yamashita Kiyoshi
Department Of Hematology And Oncology Graduate School Of Medicine University Of Tokyo
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Ono Nobuyuki
Department Of Electronics And Control Engineering Nagano National College Of Technology
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Matsumoto Masanori
Department Of Anesthesiology Nagasaki University School Of Medicine
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Kawano Noriaki
Department Of Hematology Harasanshin Hospital
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Inoue Yasushi
Department of Applied Physics, Osaka University
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Ono Nobuyuki
Department of Internal Medicine, Miyazaki Prefectural Hospital, Japan
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Kuriyama Takuro
Department of Internal Medicine, Miyazaki Prefectural Hospital
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Sugio Yasuhiro
Department of Internal Medicine, Miyazaki Prefectural Hospital, Japan
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Kodama Kieko
Department of Internal Medicine, Miyazaki Prefectural Hospital, Japan
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Iino Hisayo
Department of Blood Transfusion Medicine, Nara Medical University, Japan
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Makino Shigeyoshi
Department of Internal Medicine, Miyazaki Prefectural Hospital, Japan
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Yokota-Ikeda Naoko
Department of Internal Medicine, Miyazaki Prefectural Hospital, Japan
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Yamashita Kiyoshi
Department of Internal Medicine, Miyazaki Prefectural Hospital, Japan
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Yoshida Shuro
Department of Internal Medicine, Miyazaki Prefectural Hospital, Japan
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Uezono Shigehiro
Department of Internal Medicine, Miyazaki Prefectural Hospital, Japan
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Shimao Yoshiya
Department of Pathlogy, Miyazaki Prefectural Hospital, Japan
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Ueda Akira
Department of Internal Medicine, Miyazaki Prefectural Hospital, Japan
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