Does cryosupernatant plasma improve outcome in thrombotic thrombocytopenic purpura? No answer yet

Abstract

Summary A randomized prospective trial compared cryosupernatant plasma (CSP) to fresh frozen plasma (FFP) for treatment of thrombotic thrombocytopenic purpura (TTP). A total of 236 patients were required: 28 patients were treated with CSP and 24 with FFP within 30 months. There were no differences in survival at 1 month. By day 9, 17 of 26 patients with CSP and 18 of 24 with FFP had a platelet count >100 × 109/l. At entry, von Willebrand factor (VWF) multimers were normal in all patients (range 1·1–3·95 IU/ml). ADAMTS‐13 levels showed large variations ranging from 10% to 100% activity. At entry, no individual had <5% VWF cleaving protease. By day 9 (end of cycle), 89% (FFP) and 67% (CSP) had levels >50% of the controls. At 6 months some patients showed inhibitors to the enzyme in spite of adequate or normal platelet counts. The data from this study do not show an apparent advantage to the use of CSP in TTP. A large number of patients will be required to determine appropriate replacement therapy. We were not able to find a statistically significant relationship between the low level of protease activity at presentation of TTP and response.

High versus standard dose methylprednisolone in the acute phase of idiopathic thrombotic thrombocytopenic purpura: a randomized study

“…However, the Canadian Apheresis Group recently performed a randomized, prospective trial to assess whether cryosupernatant is better than fresh frozen plasma as replacement fluid for PE [8]. Patients received 7 PEs during the first 9 days; antiplatelet therapy was optional while steroid were prohibited.…”

“…Cryosupernatant was used based on a pilot study by the Canadian Apheresis Group suggesting that this replacement fluid was more effective than fresh frozen plasma [7]. However, a subsequent, randomized study by the same group failed to confirm this finding and concluded that the two treatments were equivalent [8].…”

Cryosupernatant and Immunosuppression as Effective Alternative Therapies for TTP in Three Pediatric SLE Patients

“…Cryosupernatant is the blood product which is the remnant after separating cryoprecipitate. Cryosupernatant is deficient in vWF and rich in ADAMTS13, so theoretically plasma exchange using cryosupernatant is better than plasma exchange with FFP, however large clinical trials are needed to prove its practical effectiveness [9]. All the children in this series responded well to treatment with cryosupernatant.…”

The experience of treating patients with thrombotic thrombocytopenic purpura with solvent detergent plasma – response to McCarthy

“…A subsequent, as yet unpublished work, in which we treated 26 patients with SDP and 34 with CSP also failed to show a difference in outcome although, again, it must be stressed that statistical significance was not achieved and it will require very large numbers of patients (probably > 200) to compare mortality in these two forms of therapy. As we previously stated (Rock et al, 2005) -without large numbers of patients -no answer yet. …”

“…In our paper (Rock et al, 2005), we described a study that was designed to compare cryosupernatant plasma (CSP) with fresh frozen plasma (FFP) in the treatment of TTP. The study was designed to enter a total of 236 patients, but was halted due to a lack of funding after only 52 patients were entered.…”