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ASLANER AK M, SAHİP B. İmmun Trombositopenili Hastalarda Dörtlü Tedavi. KONURALP TIP DERGISI 2022. [DOI: 10.18521/ktd.1130819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Amaç:İmmün trombositopeni tedavisinde son yıllarda deksametazon, rituksimab ve siklosporin kombinasyon tedavileri umut verici sonuçlar vermiştir. Bu çalışmada, immün trombositopenide verilen kombinasyon tedavilerinin eltrombopag ile birleştirilmesiyle oluşturulan dörtlü tedavinin hastalardaki yanıtlarının araştırılması amaçlanmıştır.
Yöntem:İmmun trombositopeni tanısı almış birinci basamak tedavide steroid, 2.basamak tedavide eltrombopag alan, tam ya da kısmı remisyon sağlanamayan 4 hasta retrospektif olarak aldıkları tedavi ve yanıt oranları açısından değerlendirdi.
Sonuç:Relaps /refrakter immün trombositopenisi olan hastalar, eltrombopag tedavisine ek olarak oral deksametazon, oral siklosporin ve intravenöz düşük doz rituksimab ile tedavi edildi. Eltrombopag tedavisine 50 mg/gün dozunda devam edildi. Siklosporin için yükleme dozu verilmedi, haftalık kan siklosporin düzeyi toksisite açısından izlendi ve tedavi 200 ile 400 µg/L'lik bir hedef doza titre edildi. Toksisite kaynaklı ölüm, tedaviye bağlı ciddi advers olaylar veya tedaviye uyumsuzluk gözlenmedi. 6 aylık yanıt oranı %75 idi ve tedavi iyi tolere edildi. Hastalarımızdan iki tanesi halen tam yanıtlı olarak tarafımızca takipli iken bir hastamızda 6.aydan sonra relaps olması nedeniyle splenektomi yapılmış olup halen eltrombopag tedavi ile takiplidir. Yanıtsız olan daha önce splenektomili olan hastamıza ise romiplastim tedavisi uygulandı ancak bu tedaviye de yanıt alınamadı. Hasta klinik çalışmaya dahil edildi.
Sonuç:Tedaviye dirençli immün trombositopenili hastalarda dörtlü tedavi kombinasyonunun bir tedavi seçeneği olabileceğini gösteren çalışmamız umut vaad etmektedir.
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Affiliation(s)
| | - Birsen SAHİP
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ ERZURUM BÖLGE EĞİTİM VE ARAŞTIRMA MERKEZİ
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Fattizzo B, Cantoni S, Giannotta JA, Bandiera L, Zavaglia R, Bortolotti M, Barcellini W. Efficacy and safety of cyclosporine A treatment in autoimmune cytopenias: the experience of two Italian reference centers. Ther Adv Hematol 2022; 13:20406207221097780. [PMID: 35585968 PMCID: PMC9109490 DOI: 10.1177/20406207221097780] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/13/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Immune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA) show
good responses to frontline steroids. About two-third of cases relapse and
require second-line treatment, including rituximab, mainly effective in
AIHA, and thrombopoietin-receptor agonists (TPO-RAs) in ITP, while the use
of splenectomy progressively decreased due to concerns for
infectious/thrombotic complications. For those failing second line,
immunosuppressants may be considered. Objectives: The aim of this study was to evaluate the efficacy of cyclosporine treatment
in patients with ITP and AIHA. Design: In this retrospective study, we evaluated the efficacy and safety of
cyclosporine A (CyA) in ITP (N = 29) and AIHA
(N = 10) patients followed at two reference centers in
Milan, Italy. Methods: Responses were classified as partial [Hb > 10 or at least 2 g/dl increase
from baseline, platelets (PLT) > 30 × 109/l with at least
doubling from baseline] and complete (Hb > 12 g/dl or
PLT > 100 × 109/l) and evaluated at 3, 6, and 12 months.
Treatment emergent adverse events were also registered. Results: The median time from diagnosis to CyA was 35 months (3–293), and patients had
required a median of 4 (1–8) previous therapy lines. Median duration of CyA
was 28 (2–140) months and responses were achieved in 86% of ITP and 50% of
AIHA subjects. Responders could reduce or discontinue concomitant treatment
and resolved PLT fluctuations on TPO-RA. CyA was generally well tolerated,
and only two serious infectious complications in elderly patients on
concomitant steroids suggesting caution in this patient population. Conclusion: CyA may be advisable in ITP, which is not well controlled under TPO-RA, and
in AIHA failing rituximab, particularly if ineligible in clinical trial.
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Affiliation(s)
- Bruno Fattizzo
- Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, via F. Sforza 35, 20100 Milan, Italy
| | - Silvia Cantoni
- Hematology Unit, Hematology & Oncology Department, Niguarda Cancer Center, ASST Ospedale Niguarda, Milan, Italy
| | | | - Laura Bandiera
- Pathology Unit, Hematology & Oncology Department, Niguarda Cancer Center, ASST Ospedale Niguarda, Milan, Italy
| | - Rachele Zavaglia
- Department of Oncology and Hemato-Oncologyilan, University of Milan, Italy
| | - Marta Bortolotti
- Department of Oncology and Hemato-Oncologyilan, University of Milan, Italy
| | - Wilma Barcellini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
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Fu L, Ma J, Gu H, Ma J, Wei Y, Chen Z, Wu R. An escalating treatment strategy for children with severe chronic immune thrombocytopenia: Preliminary report from a single center. Pediatr Blood Cancer 2021; 68:e29006. [PMID: 33720524 DOI: 10.1002/pbc.29006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To analyze the effects of escalating treatment strategy in children with severe chronic immune thrombocytopenia (SCITP). METHODS This was a single-center, retrospective cohort study. Data from children with SCITP who received escalating treatment strategy in our center were collected between June 2017 and August 2019. The escalating strategy included three steps: Step I (six courses of high-dose dexamethasone [HDD]), Step II (HDD combined with low-dose rituximab), and Step III (eltrombopag). RESULTS A total of 30 cases (18 males and 12 females) were included, with duration of immune thrombocytopenia (ITP) of 20.5 (12.0-96.0) months. After treatment, the remission rate was 36.7% (11/30) and the sustained response (SR) rate was 68.2% (15/22). The distribution (remission rates) from Step I to III was as follows: nine of 30 (33.3%, 3/9); four of 30 (50%, 2/4); 17/30 (29.4%, 5/17), respectively. In eltrombopag (Step III) cases, 47.5% (8/17) maintained a platelet count of ≥50 × 109 /L, 37.5% (3/8) had dose tapering, and 25% (2/8) have successfully discontinued the medication. The number of patients at 12, 24, and 36 months were 30, seven, and two, with a total response and remission rates of 80% (36.7%), 57.1% (28.6%), and 50% (50%), respectively. The total relapse rate was 26.7% (8/30), and three cases from Step II and five cases from Step III. CONCLUSION The escalating strategy for children SCITP showed an effective improvement rate with 36.7% remission and 68.2% SR, and 30% could benefit and retain SR from HDD treatment. Combined treatment with eltrombopag can reduce the relapse rate of low-dose rituximab.
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Affiliation(s)
- Lingling Fu
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, China.,National Key Discipline of Pediatrics (Capital Medical University), Beijing, China.,Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Jie Ma
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, China.,National Key Discipline of Pediatrics (Capital Medical University), Beijing, China.,Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Hao Gu
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, China.,National Key Discipline of Pediatrics (Capital Medical University), Beijing, China.,Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Jingyao Ma
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, China.,National Key Discipline of Pediatrics (Capital Medical University), Beijing, China.,Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Yunyun Wei
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, China.,National Key Discipline of Pediatrics (Capital Medical University), Beijing, China.,Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Zhengping Chen
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, China.,National Key Discipline of Pediatrics (Capital Medical University), Beijing, China.,Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Runhui Wu
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, China.,National Key Discipline of Pediatrics (Capital Medical University), Beijing, China.,Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
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