{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T04:29:00Z","timestamp":1790051340774,"version":"4.0.1"},"reference-count":45,"publisher":"American Society of Hematology","issue":"1","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,11,30]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The advent of plasma exchange has dramatically changed the prognosis of acute thrombotic thrombocytopenic purpura (TTP). Recent insights into TTP pathogenesis have led to the development of novel therapies targeting pathogenic anti-ADAMTS13 antibody production, von Willebrand factor (VWF)\u2013platelet interactions, and ADAMTS13 replacement. Retrospective and prospective studies have established the efficacy of rituximab as an adjunct to plasma exchange for patients with acute TTP, either upfront or for refractory disease. Relapse prevention is a major concern for survivors of acute TTP, and emerging data support the prophylactic use of rituximab in patients with persistent or recurrent ADAMTS13 deficiency in clinical remission. Capalcizumab, a nanobody directed against domain A1 of VWF that prevents the formation of VWF\u2013platelet aggregates, recently completed phase 2 (TITAN) and 3 (HERCULES) trials with encouraging results. Compared with placebo, caplacizumab shortened the time to platelet recovery and may protect against microthrombotic tissue injury in the acute phase of TTP, though it does not modify the underlying immune response. Other promising therapies including plasma cell inhibitors (bortezomib), recombinant ADAMTS13, N-acetyl cysteine, and inhibitors of the VWF\u2013glycoprotein Ib\/IX interaction (anfibatide) are in development, and several of these agents are in prospective clinical studies to evaluate their efficacy and role in TTP. In the coming years, we are optimistic that novel therapies and international collaborative efforts will usher in even more effective, evidence-based approaches to address refractory acute TTP and relapse prevention.<\/jats:p>","DOI":"10.1182\/asheducation-2018.1.539","type":"journal-article","created":{"date-parts":[[2019,4,16]],"date-time":"2019-04-16T22:13:59Z","timestamp":1555452839000},"page":"539-547","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":48,"title":["Beyond plasma exchange: novel therapies for thrombotic thrombocytopenic purpura"],"prefix":"10.1182","volume":"2018","author":[{"given":"Kathryn","family":"Dane","sequence":"first","affiliation":[{"name":"Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shruti","family":"Chaturvedi","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","reference":[{"issue":"21","key":"2019111521292778500_B1","doi-asserted-by":"crossref","first-page":"2836","DOI":"10.1182\/blood-2016-10-709857","article-title":"Thrombotic thrombocytopenic purpura","volume":"129","author":"Joly","year":"2017","journal-title":"Blood"},{"issue":"6","key":"2019111521292778500_B2","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1056\/NEJM199108083250604","article-title":"Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura","volume":"325","author":"Rock","year":"1991","journal-title":"N Engl J Med"},{"issue":"6","key":"2019111521292778500_B3","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1056\/NEJM199108083250605","article-title":"Improved survival in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. 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