TO THE EDITOR:

The introduction of plasmapheresis with plasma exchange has increased survival in patients with thrombotic thrombocytopenic purpura (TTP) from <10% to 80%. More than 30% of patients with TTP have at least 1 relapse within 2 years. Treatment with rituximab normalizes ADAMTS13 and induces durable remissions in >90% of patients with refractory or relapsing TTP. Rituximab is increasingly used in the upfront setting with evidence of improved rates of remission and disease-free interval.4,5 

The standard dosing regimen for rituximab is 375 mg/m2 weekly for 4 weeks, which is the dose adopted from regimens developed to treat of non-Hodgkin lymphoma. In autoimmune conditions with a lower total lymphocyte mass, an efficacious dose of rituximab is likely less than what is administered for the treatment of lymphoma. Lower doses of rituximab are attractive...

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