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O-09 THERAPEUTIC PLASMA EXCHANGE IN PATIENTS WITH THROMBOTIC THROMBOCYTOPENIC PURPURA: A RETROSPECTIVE MULTICENTER STUDY
Oral presentations / Transfusion and Apheresis Science 47 (2012) S1–S19
each, one week apart), several plasmapheresis procedures (imunoadsorption or plasma exchange), three anti-CD20 courses, and immunosuppressive therapy (mycophenolate mofetil and tacrolimus combination). Surprisingly, even in the presence of elevated anti-HLA antibodies, we observed a beneficial effect on cardiac function, with an improvement in left ventricular ejection fraction (LVEF) from 22% to 40%, suggesting that reduction in circulating auto-antibodies may be beneficial in the management of this subgroup of DCM patients. The sodium equilibrium achieved from optimized dialyses over four months could also have contributed to this improvement. Reduction of circulating auto-antibodies and immunomodulation with this protocol may contribute to the management of patients with DCM. As a result of the improvement in LVEF, the patient was removed from the heart transplant waiting list and is presently waiting for a kidney transplant. The identification of the subgroup of DCM patients with cardiac auto-antibodies is important, because most are potential heart transplant candidates. Further data are needed to finetune the prognostic criteria and humoral markers that could predict the efficacy of immunomodulatory treatment in these patients. This protocol may improve cardiac function and represents a promising therapeutic approach. O-09 THERAPEUTIC PLASMA EXCHANGE IN PATIENTS WITH THROMBOTIC THROMBOCYTOPENIC PURPURA: A RETROSPECTIVE MULTICENTER STUDY S. Korkmaz1 , M. Keklik2 , S. Sivgin2 , R. Yildirim3 , A. Tombak4 , M. Emin Kaya5 , D. Yanardag Acik6 , R. Esen7 , S. Kabukcu8 , M. Sencan1 , I. Kiki3 , E.N. Tiftik4 , I. Kuku5 , V. Okan6 , M. Yilmaz6 , C. Demir7 , I. Sari8 , F. Altuntas9 , A. Unal2 , O. Ilhan10 . 1 Cumhuriyet University, Department of Hematology, Sivas, Turkey; 2 Erciyes University, Department of Hematology, Kayseri, Turkey; 3 Atat¨ urk University, Department of Hematology, Erzurum, Turkey; 4 Mersin University, Department of Hematology, Mersin, Turkey; 5 Inonu University, Department of Hematology, Malatya, Turkey; 6 Gaziantep University, Department of Hematology, Gaziantep, Turkey; 7 Yuzuncu Yil University, Department of Hematology, Van, Turkey; 8 Pamukkale University, Department of Hematology, Denizli, Turkey; 9 Ankara Oncology Research and Education Hospital, Department of Hematology, Ankara, Turkey; 10 Ankara University, Ibni Sina Hospital, Department of Hematology, Ankara, Turkey Thrombotic thrombocytopenic purpura (TTP) is a particular form of thrombotic microangiopathy typically characterized by thrombocytopenia, microangiopathic hemolytic anemia, fever, neurological abnormalities, and renal dysfunction. TTP requires a rapid diagnosis and an adapted management in emergency. Daily sessions of therapeutical plasma exchange (TPE) remain the basis of management of TTP. We aimed to present our experience in 163 patients with TTP treated with TPE during the past five years. 163 patients with TTP treated with TPE during the past five years from eight centers of Turkey were retrospectively evaluated. TPE was carried out 1–1.5 times plasma volume. Fresh frozen plasma (FFP) was used as the replacement fluid. TPE was performed daily until normalization of serum LDH
S5
and recovery of the platelet count to >150×109 /dL. TPE was then slowly tapered. Clinical data, the number of TPE, other given therapy modalities, treatment outcomes, survival rates and TPE complications were recorded. 58% of the patients were females (n = 95). The median age of the patients was 42 years (16–82). The median age of male patients was significantly higher than female (53 vs 34 years; p < 0.001). All patients had thrombocytopenia and microangiopathic hemolytic anemia. At the same time, 83% of patients had neurological abnormalities, 79% of patients had renal dysfunction, and 89% of patients had fever. Also, 10.4% of patients had three of the five criteria (n = 17), 10.4% of patients had four of the five criteria (n = 17), and 6.1% of patients had all of the five criteria (n = 10). Primary TTP comprised of 86% of the patients (n = 140) and secondary TTP comprised of 14% of the patients (n = 23). Malignancy was the most common cause in secondary TTP. The median number of TPE was 13 (min = 1.0; max = 80). Complete response (CR) was achieved in 85% of the patients (n = 139). CR was not achieved in 15% of the patients (n = 24) and these patients died of TTP related causes. The number of TPE was significantly higher in CR patients (median 15.0 vs 3.5; p < 0.001). Similar results were achieved with TPE in both primary and secondary TTP (85% vs 87%, respectively; p = 0.806). While CR rate was 87% in patients with thrombocytopenia and microangiopathic hemolytic anemia, was CR rate 82% in patients with thrombocytopenia and microangiopathic hemolytic anemia plus one of any other three criteria (p = 0.449). CR rate was 90% in patients who had all five criteria. TPE is an effective treatment for TTP and is associated with high CR rate in both primary and secondary TTP. Thrombocytopenia together with microangiopathic hemolytic anemia is mandatory for the diagnosis of TTP and if these two criteria met in a patient, TPE should be performed immediately. O-10 ONE WEEK EDUCATION IN APHERESIS AT DHARMAIS NATIONAL CANCER HOSPITAL H. Vrielink1 , B. Eka2 , Y. Lubis2 , R. Hukom2 . 1 Sanquin Blood Supply Foundation, The Netherlands; 2 Apheresis Unit, Dharmais Hospital Jakarta, Indonesia In Indonesia, an increasing number of apheresis procedures are performed. Single donor platelets are collected at six Blood Transfusion Services and five hospitals. Also therapeutic apheresis procedures are performed in all of these hospitals. In the last 3 years, in Indonesia in total 448 therapeutic apheresis procedures (TPE, leuko- and platelet reduction, and PBSC collection) were performed of which 146 (32.5%) in the Dharmais Cancer Hospital. More hospitals in East Java planned to start a therapeutic apheresis service and asked for education of physicians and nurses. Therefore, a 1 week educational program to increase the knowledge, skills and capability of apheresis nurses to perform therapeutic apheresis procedures was developed and organised (August 2010) at the Dharmais Hospital in Jakarta. The educational program was build-up of a curriculum including: 1. Basic hematology, including the characteristics, kinetics, physiology and function of
each, one week apart), several plasmapheresis procedures (imunoadsorption or plasma exchange), three anti-CD20 courses, and immunosuppressive therapy (mycophenolate mofetil and tacrolimus combination). Surprisingly, even in the presence of elevated anti-HLA antibodies, we observed a beneficial effect on cardiac function, with an improvement in left ventricular ejection fraction (LVEF) from 22% to 40%, suggesting that reduction in circulating auto-antibodies may be beneficial in the management of this subgroup of DCM patients. The sodium equilibrium achieved from optimized dialyses over four months could also have contributed to this improvement. Reduction of circulating auto-antibodies and immunomodulation with this protocol may contribute to the management of patients with DCM. As a result of the improvement in LVEF, the patient was removed from the heart transplant waiting list and is presently waiting for a kidney transplant. The identification of the subgroup of DCM patients with cardiac auto-antibodies is important, because most are potential heart transplant candidates. Further data are needed to finetune the prognostic criteria and humoral markers that could predict the efficacy of immunomodulatory treatment in these patients. This protocol may improve cardiac function and represents a promising therapeutic approach. O-09 THERAPEUTIC PLASMA EXCHANGE IN PATIENTS WITH THROMBOTIC THROMBOCYTOPENIC PURPURA: A RETROSPECTIVE MULTICENTER STUDY S. Korkmaz1 , M. Keklik2 , S. Sivgin2 , R. Yildirim3 , A. Tombak4 , M. Emin Kaya5 , D. Yanardag Acik6 , R. Esen7 , S. Kabukcu8 , M. Sencan1 , I. Kiki3 , E.N. Tiftik4 , I. Kuku5 , V. Okan6 , M. Yilmaz6 , C. Demir7 , I. Sari8 , F. Altuntas9 , A. Unal2 , O. Ilhan10 . 1 Cumhuriyet University, Department of Hematology, Sivas, Turkey; 2 Erciyes University, Department of Hematology, Kayseri, Turkey; 3 Atat¨ urk University, Department of Hematology, Erzurum, Turkey; 4 Mersin University, Department of Hematology, Mersin, Turkey; 5 Inonu University, Department of Hematology, Malatya, Turkey; 6 Gaziantep University, Department of Hematology, Gaziantep, Turkey; 7 Yuzuncu Yil University, Department of Hematology, Van, Turkey; 8 Pamukkale University, Department of Hematology, Denizli, Turkey; 9 Ankara Oncology Research and Education Hospital, Department of Hematology, Ankara, Turkey; 10 Ankara University, Ibni Sina Hospital, Department of Hematology, Ankara, Turkey Thrombotic thrombocytopenic purpura (TTP) is a particular form of thrombotic microangiopathy typically characterized by thrombocytopenia, microangiopathic hemolytic anemia, fever, neurological abnormalities, and renal dysfunction. TTP requires a rapid diagnosis and an adapted management in emergency. Daily sessions of therapeutical plasma exchange (TPE) remain the basis of management of TTP. We aimed to present our experience in 163 patients with TTP treated with TPE during the past five years. 163 patients with TTP treated with TPE during the past five years from eight centers of Turkey were retrospectively evaluated. TPE was carried out 1–1.5 times plasma volume. Fresh frozen plasma (FFP) was used as the replacement fluid. TPE was performed daily until normalization of serum LDH
S5
and recovery of the platelet count to >150×109 /dL. TPE was then slowly tapered. Clinical data, the number of TPE, other given therapy modalities, treatment outcomes, survival rates and TPE complications were recorded. 58% of the patients were females (n = 95). The median age of the patients was 42 years (16–82). The median age of male patients was significantly higher than female (53 vs 34 years; p < 0.001). All patients had thrombocytopenia and microangiopathic hemolytic anemia. At the same time, 83% of patients had neurological abnormalities, 79% of patients had renal dysfunction, and 89% of patients had fever. Also, 10.4% of patients had three of the five criteria (n = 17), 10.4% of patients had four of the five criteria (n = 17), and 6.1% of patients had all of the five criteria (n = 10). Primary TTP comprised of 86% of the patients (n = 140) and secondary TTP comprised of 14% of the patients (n = 23). Malignancy was the most common cause in secondary TTP. The median number of TPE was 13 (min = 1.0; max = 80). Complete response (CR) was achieved in 85% of the patients (n = 139). CR was not achieved in 15% of the patients (n = 24) and these patients died of TTP related causes. The number of TPE was significantly higher in CR patients (median 15.0 vs 3.5; p < 0.001). Similar results were achieved with TPE in both primary and secondary TTP (85% vs 87%, respectively; p = 0.806). While CR rate was 87% in patients with thrombocytopenia and microangiopathic hemolytic anemia, was CR rate 82% in patients with thrombocytopenia and microangiopathic hemolytic anemia plus one of any other three criteria (p = 0.449). CR rate was 90% in patients who had all five criteria. TPE is an effective treatment for TTP and is associated with high CR rate in both primary and secondary TTP. Thrombocytopenia together with microangiopathic hemolytic anemia is mandatory for the diagnosis of TTP and if these two criteria met in a patient, TPE should be performed immediately. O-10 ONE WEEK EDUCATION IN APHERESIS AT DHARMAIS NATIONAL CANCER HOSPITAL H. Vrielink1 , B. Eka2 , Y. Lubis2 , R. Hukom2 . 1 Sanquin Blood Supply Foundation, The Netherlands; 2 Apheresis Unit, Dharmais Hospital Jakarta, Indonesia In Indonesia, an increasing number of apheresis procedures are performed. Single donor platelets are collected at six Blood Transfusion Services and five hospitals. Also therapeutic apheresis procedures are performed in all of these hospitals. In the last 3 years, in Indonesia in total 448 therapeutic apheresis procedures (TPE, leuko- and platelet reduction, and PBSC collection) were performed of which 146 (32.5%) in the Dharmais Cancer Hospital. More hospitals in East Java planned to start a therapeutic apheresis service and asked for education of physicians and nurses. Therefore, a 1 week educational program to increase the knowledge, skills and capability of apheresis nurses to perform therapeutic apheresis procedures was developed and organised (August 2010) at the Dharmais Hospital in Jakarta. The educational program was build-up of a curriculum including: 1. Basic hematology, including the characteristics, kinetics, physiology and function of