[Treatment of thrombotic thrombopenic purpura. Results of a multicenter randomized clinical study]

A controlled multicentre trial was conducted in France over a period of five years in 40 patients with thrombotic thrombocytopenic purpura (TTP) to try to determine the best treatment of this disease. Patients presenting eligibility criteria were centrally randomized into two therapeutic groups: Group A) daily plasma exchanges with a solution of fresh frozen plasma (15 ml/kg) in albumin (45 ml/kg) versus Group B) daily transfusions of fresh frozen plasma (15 ml/kg), both systematically associated with intravenous antiplatelet therapy. When the treatment was started early after the first symptoms of TTP, there was no significant difference among plasma exchange and plasma transfusion. But the later the treatment was started, the lesser was the initial therapeutic response and the poorer the prognosis. Furthermore, the excessive use of plasma transfusions in initially unresponsive patients could be dangerous, resulting in some cases in irreversible development of the disease. The overall survival rate in groupe A was 85 percent with 80 percent complete remissions and 15 percent deaths, as opposed to a 57 percent survival rate with 52 percent complete remission and 43 percent deaths in groupe B. Thus plasma exchanges with fresh frozen plasma if started early and performed daily in sufficient amounts, appear to be undoubtedly safer than plasma transfusions.