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Background: Rituximab can induce a durable remission in plasma exchange refractory thrombotic thrombocytopenic purpura (TTP). Timing of Rituximab infusion in combination with plasma exchange (PE) and long term follow-up for probable side effects of such treatment is still lacking.
Methods: This study was conducted among 10 patients with plasma exchange refractory TTP. According to the study designation, first PE was performed within 36-48 hours after first dose of rituximab.
Results: Eight of ten (80%) patients received 1 course of rituximab. Two of ten (20%) patients received another course of rituximab due to relapse. Repsonse rate (RR) to rituximab in combination with plasma exchange, was 90%. Overall Survival of the patients was 90% and 1 and 5-year relapse free survival rate (RFS) was 90% and 83%, respectively. One of the patients expired due to Systemic Lupus Erythematosus flare up.
Conclusion: According to this study, treatment of refractory TTP with rituximab in combination with PE could be effective.
Iranian Registry of Clinical Trials: IRCT2017012232125N1

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Background: Cisplatin is an antineoplastic agent used to treat many malignancies; however, the main side effect of cisplatin is nephrotoxicity. The aim of this study was to evaluate the effect of hydration therapy with and without magnesium on prevention of cisplatin-induced nephrotoxicity.
Methods: This retrospective study was performed on 46 patients with malignancy who were candidate to receive cisplatin as their protocol for chemotherapy during years 2011-2016. Of these, 22 patients were treated with hydration and magnesium sulfate (1 gr magnesium sulfate 50% and 10 mEq potassium chloride 15% in 1000 ml normal saline before and after cisplatin administration) and 24 patients were treated with hydration alone. Cisplatin was administered in cycles every 21 days. Serum sodium, Potassium, creatinine (sCr) and creatinine clearance (CrCl) were assessed before each chemotherapy cycle and after the last course of chemotherapy.
Results: There was significant difference between two studied groups in post chemotherapy sCr and Potassium (P<0.05); however, no significant difference was observed between two groups in serum magnesium and sodium levels (P>0.05). In terms of sCr, as nephrotoxicity index, the absolute risk of nephrotoxicity in patients receiving hydration with magnesium was 19% more than the other group. The relative risk of nephrotoxicity in patients receiving hydration with magnesium was 4.4 fold more than another group.
Conclusion: Risk of cisplatin-induced nephrotoxicity in patients receiving hydration with magnesium sulfate was higher than group of patients not receiving magnesium besides hydration.

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