Cryoprecipitate poor plasma does not improve early response in primary adult thrombotic thrombocytopenic purpura (TTP)

Thrombotic thrombocytopenic purpura (TTP) is a potentially fatal disease th at is treated with plasma exchange and typically with replacement with fres h frozen plasma (FFP). This approach results in an approximate 50% response rate following 1 week of therapy and 80% survival. Cryoprecipitate poor pl asma (CPP) is plasma from which the cryoprecipitate fraction is removed. CP P has been reported to be successful as salvage therapy in refractory TTP a nd has been suggested to he superior to FFP in retrospective studies. The p resent report compares initial therapy of TTP with exchange using replaceme nt with either FFP or CPP in a multi-institutional prospective randomized s tudy performed by the North American TTP Group (NATG Group) from 1993 to 19 95. Initial therapy also included corticosteroids. Antiplatelet drugs or vi nca alkaloids were not employed. A severity score index, response score, an d individual clinical parameters (platelet count, LDH x upper limit of norm al, hemoglobin level, and creatinine) were compared at their nadir or peak values, baseline, and days +6 and +13 of therapy. Thirteen patients were ra ndomized to FFP exchange and 14 to CPP exchange. Results were equivalent fo r all parameters. Survival was equal with three deaths in each group. These data indicate that the efficacy of FFP and CPP are the same in the initial treatment of TTP in adults. (C) 2001 Wiley-Liss, Inc.