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Dainese C, Valeri F, Pizzo E, Valpreda A, Sivera P, Montaruli B, Porreca A, Massaia M, Bruno B, Borchiellini A. ADAMTS13 Autoantibodies and Burden of Care in Immune Thrombotic Thrombocytopenic purpura: New Evidence and Future Implications. Clin Appl Thromb Hemost 2022; 28:10760296221125785. [PMID: 36124377 PMCID: PMC9490478 DOI: 10.1177/10760296221125785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The introduction Caplacizumab in the management of Immune thrombotic thrombocytopenic purpura (iTTP) has raised different questions, considering its cost-efficacy and the optimal immunosuppressive treatment (IST) to associate. A retrospective multicenter collection of 42 first iTTP cases was conducted to identify variables associated with a higher burden of care and necessity of an implemented IST with early Rituximab (RTX) rescue. A significant correlation resulted between ADAMTS13 inhibitors (ADAMTS13inh) at diagnosis with total plasma exchange (PEXtot) and PEX needed to achieve clinical response (PEXtoCR, r = 0.46; r = 0.48), along with age (r = - 0.31; r = -0.35), platelet count (r = -0.30; r = -0.30), LDH (r = 0.44; r = 0.41) and total bilirubin (r = 0.54; r = 0.35). ADAMTS13inh also correlated with number of days of hospitalization (DoH, r = 0.44). A significant difference was observed in terms of median ADAMTS13inh titer at diagnosis in patient treated with RTX rescue and those responding to only steroid treatment. Thus, ADAMTS13inh titer resulted a marker of iTTP burden of care, associated with higher number of PEXtot, PEXtoCR, DoH and higher probability of needing RTX rescue to achieve clinical response and could be a useful tool for management of new iTTP cases and an interesting variable to optimize iTTP cases stratification in future Caplacizumab cost-efficacy analysis.
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Affiliation(s)
- Cristina Dainese
- Regional Reference Center for Thrombotic and Haemorrhagic disorders of the adult, Department of Hematology and Oncology, 18691Azienda Ospedaliera Città della Salute e della Scienza di Torino - Molinette, 10126, Turin, Italy
| | - Federica Valeri
- Regional Reference Center for Thrombotic and Haemorrhagic disorders of the adult, Department of Hematology and Oncology, 18691Azienda Ospedaliera Città della Salute e della Scienza di Torino - Molinette, 10126, Turin, Italy
| | - Eleonora Pizzo
- School of Medicine, Study University of Turin, 10126 Turin, Italy
| | | | - Piera Sivera
- Hematology Unit, Ordine Mauriziano Hospital, Turin, 10128, Italy
| | - Barbara Montaruli
- Laboratory Analysis, Ordine Mauriziano Hospital, 10128, Turin, Italy
| | - Annamaria Porreca
- Department of Medical, Oral and Biotechnologies Sciences, University of Chieti-Pescara, 66100, Chieti, Italy
| | - Massimo Massaia
- Division of Hematology, "Santa Croce e Carle di Cuneo" Hospital, 12100, Cuneo, Italy
| | - Benedetto Bruno
- Hematology Unit, Department of Hematology and Oncology, Azienda Ospedaliera Città della Salute e della Scienza di Torino - Molinette, 10126, Turin, Italy
| | - Alessandra Borchiellini
- Regional Reference Center for Thrombotic and Haemorrhagic disorders of the adult, Department of Hematology and Oncology, 18691Azienda Ospedaliera Città della Salute e della Scienza di Torino - Molinette, 10126, Turin, Italy
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