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Burenbatu, Wang Y, Wang S, Narisu, Wuritunashun, Gong C, Hashengaowa, Eerdunduleng, Sarula, Guihua, Bai H. iTRAQ-based quantitative proteomics analysis of immune thrombocytopenia patients before and after Qishunbaolier treatment. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2021; 35:e8993. [PMID: 33140498 PMCID: PMC7757159 DOI: 10.1002/rcm.8993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 10/08/2023]
Abstract
RATIONALE Treatment of immune thrombocytopenia (ITP) usually involves long-term use of immunosuppressive corticosteroids and splenectomy. However, these treatments often have side effects in patients. The Mongolian medicine Qishunbaolier (QSBLE) has a high curative effect, reduces the chances of relapse, and has no obvious side effects. This study was designed to identify potential therapeutic targets of QSBLE for treating ITP. METHODS To reveal differences in protein expression between ITP patients (ITPs) before and after QSBLE treatment, comparative proteomics studies were performed using isobaric tags for relative and absolute quantification (iTRAQ). The analysis used nanospray liquid chromatography/tandem mass spectrometry (nano-LC/MS/MS) in positive ion electrospray ionization mode. Key proteins relevant to ITP were revealed by the Kyoto Encyclopedia of Genes and Genomes (KEGG) and other bioinformatics tools. Real-time polymerase chain reaction (RT-PCR) analysis was carried out for confirmation of differentially expressed proteins. RESULTS A total of 982 differentially expressed proteins were identified in ITPs compared with the controls. Compared with the pre-QSBLE treatment group, 61 differentially expressed proteins were identified in the post-QSBLE treatment group, with 48 proteins being significantly upregulated and 13 downregulated. Twenty-nine pathways were significantly enriched. Q6N030 and other proteins were the key players in the protein-pathway network. Twenty proteins that may play important roles in the treatment of ITP were further filtered. RT-PCR and Western blot analyses further confirmed that MIF, PGK1 and IGHM were upregulated in ITPs after QSBLE treatment, in accordance with the proteomics data. CONCLUSIONS It is believed that the identified proteins and the results of bioinformatics analysis will provide a potential therapeutic target site for QSBLE for ITP therapy and biomarkers.
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Affiliation(s)
- Burenbatu
- Affiliated Hospital of Inner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Yanbo Wang
- College of Life Sciences and Food SciencesInner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
- Inner Mongolia Engineering and Technical Research Center for Personalized MedicineInner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Shuanglian Wang
- Affiliated Hospital of Inner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Narisu
- Affiliated Hospital of Inner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Wuritunashun
- Affiliated Hospital of Inner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Cuiqin Gong
- Affiliated Hospital of Inner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Hashengaowa
- Affiliated Hospital of Inner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Eerdunduleng
- Affiliated Hospital of Inner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Sarula
- Affiliated Hospital of Inner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Guihua
- Affiliated Hospital of Inner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Haihua Bai
- College of Life Sciences and Food SciencesInner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
- Inner Mongolia Engineering and Technical Research Center for Personalized MedicineInner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
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Provan D, Arnold DM, Bussel JB, Chong BH, Cooper N, Gernsheimer T, Ghanima W, Godeau B, González-López TJ, Grainger J, Hou M, Kruse C, McDonald V, Michel M, Newland AC, Pavord S, Rodeghiero F, Scully M, Tomiyama Y, Wong RS, Zaja F, Kuter DJ. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv 2019; 3:3780-3817. [PMID: 31770441 PMCID: PMC6880896 DOI: 10.1182/bloodadvances.2019000812] [Citation(s) in RCA: 563] [Impact Index Per Article: 112.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/18/2019] [Indexed: 01/19/2023] Open
Abstract
Over the last decade, there have been numerous developments and changes in treatment practices for the management of patients with immune thrombocytopenia (ITP). This article is an update of the International Consensus Report published in 2010. A critical review was performed to identify all relevant articles published between 2009 and 2018. An expert panel screened, reviewed, and graded the studies and formulated the updated consensus recommendations based on the new data. The final document provides consensus recommendations on the diagnosis and management of ITP in adults, during pregnancy, and in children, as well as quality-of-life considerations.
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Affiliation(s)
- Drew Provan
- Academic Haematology Unit, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Donald M Arnold
- McMaster Centre for Transfusion Research, Department of Medicine and Department of Pathology and Molecular Medicine, McMaster University and Canadian Blood Services, Hamilton, ON, Canada
| | - James B Bussel
- Division of Hematology/Oncology, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Beng H Chong
- St. George Hospital, NSW Health Pathology, University of New South Wales, Sydney, NSW, Australia
| | - Nichola Cooper
- Department of Haematology, Hammersmith Hospital, London, United Kingdom
| | | | - Waleed Ghanima
- Departments of Research, Medicine and Oncology, Østfold Hospital Trust, Grålum, Norway
- Department of Hematology, Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | - Bertrand Godeau
- Centre de Référence des Cytopénies Auto-Immunes de l'Adulte, Service de Médecine Interne, CHU Henri Mondor, AP-HP, Université Paris-Est Créteil, Créteil, France
| | | | - John Grainger
- Department of Haematology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Ming Hou
- Department of Haematology, Qilu Hospital, Shandong University, Jinan, China
| | | | - Vickie McDonald
- Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Marc Michel
- Centre de Référence des Cytopénies Auto-Immunes de l'Adulte, Service de Médecine Interne, CHU Henri Mondor, AP-HP, Université Paris-Est Créteil, Créteil, France
| | - Adrian C Newland
- Academic Haematology Unit, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Sue Pavord
- Haematology Theme Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Francesco Rodeghiero
- Hematology Project Foundation, Affiliated to the Department of Cell Therapy and Hematology, San Bortolo Hospital, Vicenza, Italy
| | - Marie Scully
- Department of Haematology, University College London Hospital, Cardiometabolic Programme-NIHR UCLH/UCL BRC, London, United Kingdom
| | - Yoshiaki Tomiyama
- Department of Blood Transfusion, Osaka University Hospital, Osaka, Japan
| | - Raymond S Wong
- Sir YK Pao Centre for Cancer and Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Francesco Zaja
- SC Ematologia, Azienda Sanitaria Universitaria Integrata, Trieste, Italy; and
| | - David J Kuter
- Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Higashide Y, Hori T, Yoto Y, Kabutoya H, Honjo S, Sakai Y, Nojima M, Yoda M, Yamamoto M, Tsutsumi H. Predictive factors of response to IVIG in pediatric immune thrombocytopenic purpura. Pediatr Int 2018; 60:357-361. [PMID: 29297955 DOI: 10.1111/ped.13505] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 12/04/2017] [Accepted: 12/26/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Immune thrombocytopenic purpura (ITP) is commonly treated with i.v. immunoglobulin (IVIG). METHODS We retrospectively evaluated whether pretreatment clinical and laboratory finding could predict the short- and long-term response to IVIG. RESULTS Short-term response was estimated by platelet count 2 weeks after IVIG, and long-term response was assessed on thrombocytopenia-free survival (TFS). TFS was defined as the probability of survival without treatment failure after initial IVIG, such as relapse, requirement for additional therapeutic interventions, or progressing to chronic ITP. Seventy-six patients with newly diagnosed ITP who were initially treated with IVIG were evaluated. Fifty-three patients (69.7%) were determined as responders at 2 weeks after IVIG. On multivariate analysis, age ≥23 months (P = 0.020) and platelet count <9.0 × 109 /L (P = 0.018) were considered to be unfavorable factors for short-term response. Cumulative proportion of long-term (1 year) good prognosis was estimated at 53.0% (95%CI: 40.8-65.2). On multivariate analysis of unfavorable factors for long-term response, age ≥23 months (P = 0.020) was the only significant factor. CONCLUSIONS For new-onset ITP in patients aged >2 years, corticosteroid therapy in addition to IVIG may be considered as the initial treatment.
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Affiliation(s)
- Yukiko Higashide
- Department of Pediatrics, Hakodate Municipal Hospital, Hakodate, Japan
| | - Tsukasa Hori
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yuko Yoto
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroyuki Kabutoya
- Department of Pediatrics, Hakodate Municipal Hospital, Hakodate, Japan
| | - Saho Honjo
- Department of Pediatrics, Hakodate Municipal Hospital, Hakodate, Japan
| | - Yoshiyuki Sakai
- Department of Pediatrics, Hakodate Municipal Hospital, Hakodate, Japan
| | - Masanori Nojima
- Center for Translational Research, Institute of Medical Science Hospital, University of Tokyo, Tokyo, Japan
| | - Minami Yoda
- Department of Pediatrics, Hakodate Municipal Hospital, Hakodate, Japan
| | - Masaki Yamamoto
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroyuki Tsutsumi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
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Watad A, Amital H, Shoenfeld Y. Intravenous immunoglobulin: a biological corticosteroid-sparing agent in some autoimmune conditions. Lupus 2017; 26:1015-1022. [DOI: 10.1177/0961203317696589] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Intravenous immunoglobulin (IVIg) is increasingly used for the treatment of autoimmune and systemic inflammatory diseases. This compound is effective in a wide range of clinical conditions other than primary immunodeficiency, including autoimmune diseases, inflammatory disorders, infections, organ transplantation, and possibly supportive therapy for cancer. Systemic corticosteroids remain the gold standard treatment for many autoimmune diseases, but their long-term use is associated with complications in diverse organs and systems. Osteoporosis, osteonecrosis, cardiovascular disease, infections, and cancer have been associated with this treatment. Therefore, physicians are occasionally forced to withdraw the treatment with steroids. Biological agents may represent a good alternative, but in addition to being very expensive, these agents may have serious side effects. This review aimed to cover the major advances in the use of IVIg as a steroid-sparing agent in some relevant autoimmune diseases.
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Affiliation(s)
- A Watad
- Department of Medicine ‘B’, Sheba Medical Center, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - H Amital
- Department of Medicine ‘B’, Sheba Medical Center, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Y Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Burenbatu, Borjigin M, Eerdunduleng, Huo W, Gong C, Hasengaowa, Zhang G, Longmei, Li M, Zhang X, Sun X, Yang J, Wang S, Narisu N, Liu Y, Bai H. Profiling of miRNA expression in immune thrombocytopenia patients before and after Qishunbaolier (QSBLE) treatment. Biomed Pharmacother 2015; 75:196-204. [DOI: 10.1016/j.biopha.2015.07.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 07/26/2015] [Indexed: 11/16/2022] Open
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Morimoto Y, Yoshida N, Kawashima N, Matsumoto K, Kato K. Identification of predictive factors for response to intravenous immunoglobulin treatment in children with immune thrombocytopenia. Int J Hematol 2014; 99:597-602. [DOI: 10.1007/s12185-014-1551-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 02/17/2014] [Accepted: 02/18/2014] [Indexed: 01/07/2023]
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Zhang Q, Bai H, Wang W. Increased percentages of T cells producing interleukin-21 in patients with immune thrombocytopenic purpura. Cell Biol Int 2013; 38:520-5. [PMID: 24323496 DOI: 10.1002/cbin.10220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 11/05/2013] [Indexed: 01/05/2023]
Affiliation(s)
- Qian Zhang
- College of Veterinary Medicine; Gansu University of Agriculture; Lanzhou 730070 Gansu China
- Department of Hematology; Lanzhou General Hospital, Lanzhou Command; Lanzhou Gansu China
| | - Hai Bai
- Department of Hematology; Lanzhou General Hospital, Lanzhou Command; Lanzhou Gansu China
| | - Wenhui Wang
- College of Veterinary Medicine; Gansu University of Agriculture; Lanzhou 730070 Gansu China
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8
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A pilot exploration of symptom trajectories in adolescents with cancer during chemotherapy. Cancer Nurs 2013; 36:60-71. [PMID: 22561919 DOI: 10.1097/ncc.0b013e318250da1a] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Chemotherapy is frequently administered in repetitive cycles. Adolescents with cancer have multiple symptoms related to chemotherapy, but knowledge of symptom trajectories across a cycle is limited. Examining trajectories over a cycle may reveal key periods to manage symptoms. OBJECTIVES The aims of this pilot were to describe the trajectory of symptoms (pain, sleep, appetite, nausea, fatigue) and biological and behavioral variables (anxiety, stress, hematologic function) across 1 cycle and examine relationships between variables. METHODS Nine adolescents with cancer within 6 months of diagnosis participated. Data were collected by surveys, chart review, and biologic measures on days 1 and 2 of the cycle, 1 week later (nadir), and day 1 of the following cycle. To evaluate the trajectory, a simple random-effects repeated-measures analysis was computed. RESULTS The significant trajectories were fatigue (P = .003), difficulty sleeping (P = .032), and nausea (P = .04). Most of the adolescents reported some anticipatory anxiety about receiving chemotherapy. Significant correlations between symptoms and biobehavioral variables included anticipatory anxiety and nausea (r = .86, P = .003), trait anxiety and fatigue (r = -0.82, P < .001), and stress and pain (r = 0.78, P = .039). CONCLUSIONS Multiple symptoms were experienced across the cycle. Three symptoms displayed significant trajectories indicating that patterns of symptoms may be anticipated. IMPLICATIONS FOR PRACTICE Pilot findings suggest that monitoring symptoms, stress, and anxiety across a cycle is important, not only during chemotherapy administration, but also prior to being admitted for chemotherapy.
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Immune thrombocytopenia in children less than 1 year of age: a single-institution 10-year experience. J Pediatr Hematol Oncol 2013; 35:406-8. [PMID: 22767132 DOI: 10.1097/mph.0b013e3182580ab4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Immune thrombocytopenia (ITP) in children less than one year of age is less well characterized compared to ITP in toddlers and school-age children. We performed a 10-year retrospective review of ITP patients in this age-cohort at our institution. Diagnosis and classification were made according to the 2009 International Working Group criteria. Fourteen infants were identified. Their bleeding scores were Grades 1 to 2 (79%), Grade 3 (22%), Grades 4 to 5 (0%). Eight patients received treatment with a 75% response rate. Three patients (21%) developed chronic ITP. These observations suggest that ITP in very young patients is similar to typical childhood ITP.
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Zahran AM, Elsayh KI. CD4+CD25+High Foxp3+ Regulatory T Cells, B Lymphocytes, and T Lymphocytes in Patients With Acute ITP in Assiut Children Hospital. Clin Appl Thromb Hemost 2012; 20:61-7. [DOI: 10.1177/1076029612454937] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
We aimed to examine the levels of lymphocyte subsets and regulatory T cells in patients with newly diagnosed immune thrombocytopenia (ITP) and their correlation with the course of ITP. The study included 40 pediatric patients with acute ITP and 30 controls. Lymphocytes and regulatory T cells were analyzed by flow cytometry. The percentages of CD19+ and CD8+ cells were significantly increased while that of CD4+ cells and CD4+/CD8+ ratio were significantly decreased. The percentages of CD4+CD25+High and CD4+CD25+High forkhead box protein 3 (Foxp3+) cells and the expression of Foxp3+ in CD4+CD25+High cells were significantly decreased in patients. Age, platelet count, and mean platelet volume (MPV) in patients with brief duration of thrombocytopenia were significantly decreased than in those with prolonged duration. The percentages of CD8+, CD4+CD25+High, and CD4+CD25+High Foxp3+ were significantly increased in patients with brief duration. Age, platelet count and MPV, and CD8+ cells had prognostic significance. CD4+CD25+High Foxp+ T cells may be a helpful prognostic marker in children with acute ITP.
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Affiliation(s)
- Asmaa M. Zahran
- Department of Oncological Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Khalid I. Elsayh
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
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Stiakaki E, Perdikogianni C, Thomou C, Markaki EA, Katzilakis N, Tsirigotaki M, Kalmanti M. Idiopathic thrombocytopenic purpura in childhood: twenty years of experience in a single center. Pediatr Int 2012; 54:524-7. [PMID: 22647082 DOI: 10.1111/j.1442-200x.2012.03606.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder with a variable clinical course. METHODS A retrospective analysis was carried out of ITP patients presenting to a pediatric hematology-oncology department during a period of 20 years, with a focus on treatment and outcome. RESULTS One hundred and twenty-four cases were recorded (mean patient age, 8.4 years). Forty-nine children (39.5%) had platelet counts <10,000/µL at diagnosis. No episode of severe bleeding was observed. Peak incidence was observed during spring and summer. Respiratory infections proceeded in 58% of cases. Treatment consisted of i.v. immunoglobulin (IVIG) in 93 children at four dosing schedules. Sixteen children received corticosteroids, 10 children received anti-D immunoglobulin and 14 received no treatment. Recovery was observed in 67% of children on IVIG and in 50% on anti-D globulin. Eight patients did not respond initially and received corticosteroids. Three children with refractory thrombocytopenia received anti-CD20 (rituximab). Fourteen children (11%) had persistent/chronic disease. In 10 of them recovery was observed in 13 months-8 years. Splenectomy was performed in six children with resistant/chronic disease. CONCLUSION ITP has a benign course in the majority of cases. Anti-D globulin can effectively be used as an alternative first-line treatment. Rituximab can successfully be used in refractory cases, while splenectomy has currently limited indications.
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Affiliation(s)
- Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology, University of Crete, Heraklion, Crete, Greece
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Kühne T, Imbach P. Management of children and adolescents with primary immune thrombocytopenia: controversies and solutions. Vox Sang 2012; 104:55-66. [PMID: 22804721 DOI: 10.1111/j.1423-0410.2012.01636.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The management including diagnostic procedures, prophylaxis, treatment and follow-up of patients with primary immune thrombocytopenia (ITP) in childhood is controversial due to limited clinical data, difficulties in the estimation of individual bleeding risk and heterogeneity of pathophysiology potentially causing various treatment responses. Advances in the management of children include increased international collaborations, improved quality of diagnosis and treatment, increased clinical data, refinement of consensus statements where clinical evidence is absent, new drugs and last but not least establishment of watch-and-wait strategies. The Intercontinental Cooperative ITP Study Group promotes international collaboration since more than 10 years based on a worldwide network and experience in registries. Future considerations include concentration of available resources, strengthening international collaboration, focusing on most important scientific and clinical questions, such as identification of the subgroup of patients that benefits most from prophylactic platelet-enhancing treatments and investigation of treatment endpoints other than concepts solely based on the platelet count, including bleeding symptoms, health-related quality of life and economical aspects of treatments.
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Affiliation(s)
- T Kühne
- Division of Oncology/Hematology, University Children's Hospital, Basel, Switzerland.
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Escudero Vilaplana V, Aragonés JH, Fernández-Llamazares CM, Bieler CB, Rodríguez SM, Sáez MS. Use of romiplostim for primary immune thrombocytopenia in children. Pediatr Hematol Oncol 2012; 29:197-205. [PMID: 22376020 DOI: 10.3109/08880018.2011.629401] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Very little has been published on the use of romiplostim to treat primary immune thrombocytopenia (ITP), refractory to previous treatments, in children. The objective of this study was to determine its efficacy and safety in pediatric patients in a university general hospital. Retrospective, longitudinal observational study of pediatric patients on treatment with romiplostim. The principal efficacy variable was platelet count. Safety was evaluated by recording possible adverse reactions to the medication, monitoring the appearance of thrombosis, thrombocytopenia during dose reduction, hemorrhage, and myelodysplastic syndromes. Three patients in the authors' center have been treated with romiplostim (subcutaneous [SC], initial dose: 1 μg/kg/week) for ITP refractory to various treatments: 1 with newly diagnosed ITP and 2 with chronic ITP. Patients were followed up for 27 to 39 weeks after starting treatment. Responses were achieved in 7 to 28 days, and complete responses were maintained for 37% to 91% of the follow-up period, with median platelet counts between 40 × 10(3)/μL and 215 × 10(3)/μL. The adverse reactions observed during follow-up were headache and asthenia in one patient and mucocutaneous bleeding after dose suspension in another one. With regard to effectiveness, the response in the 3 patients was varied. The drug was considered to be safe, as there were only mild adverse reactions. Although further studies and long-term follow-up are required, these results show that romiplostim could be considered an alternative to immunosuppressive therapies, such as rituximab, or splenectomy in refractory chronic ITP.
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Ahmed I, Rajpurkar M, Thomas R, Chitlur M. Initial lymphocyte count and the development of persistent/chronic immune thrombocytopenic purpura. Pediatr Blood Cancer 2010; 55:508-11. [PMID: 20658623 DOI: 10.1002/pbc.22570] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute immune thrombocytopenic purpura (ITP) is a common, benign, self-limiting disease in children. Chronic ITP is diagnosed when thorombocytopenia persists beyond 12 months. Older age is associated with increased risk for development of chronic ITP. The main objective of the current study was to examine whether total leukocyte (TLC) and absolute lymphocyte counts (ALC) at diagnosis correlate with the persistence of ITP beyond 6 months. PROCEDURE Two hundred and twenty four consecutive medical records for patients diagnosed with immune thrombocytopenia, between April 1993 and July 2007, were reviewed and 188 patients were eligible for analysis. Case records were examined to ascertain the following information: age, gender, ethnicity, date of presentation, presenting CBC with differential count, treatment given and the outcome. RESULTS The male to female ratio was almost 1:1; 24% (45/188) of patients had persistent ITP beyond 6 months. We determined that age >8.5 year, TLC < 6,250/microl and ALC < 3,050/microl was associated with a significant risk for development of persistent ITP beyond 6 months. CONCLUSIONS TLC and ALC at diagnosis are predictive variables for the development of persistent/chronic ITP. Further studies are recommended to confirm the current finding and to assess the underlying pathophysiology with the course of the ITP.
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Affiliation(s)
- Ibrahim Ahmed
- The Carman and Ann Adams Department of Pediatrics, Pediatric Hematology/Oncology Division, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, USA.
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Bussel JB. Traditional and new approaches to the management of immune thrombocytopenia: issues of when and who to treat. Hematol Oncol Clin North Am 2010; 23:1329-41. [PMID: 19932437 DOI: 10.1016/j.hoc.2009.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Diagnosis and management of chronic ITP requires experience and the appropriate use of the laboratory despite the absence of a diagnostic test for ITP. Consideration of secondary ITP is important because identification of immunodeficiency infections or of lymphoproliferative disorders would change the management approach to a given patient. The development of newer therapies such as rituximab and the thrombopoietic agents has had a major impact on the management of ITP. In the future, combinations of agents may be a critical approach although the schedule and dosing remains difficult to establish. Finally, current studies to augment therapy in newly diagnosed ITP patients to prevent chronic disease may lessen the number of patients in chronic disease category.
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Affiliation(s)
- James B Bussel
- Department of Pediatrics, Weill Medical College of Cornell University, 525 E 68th Street, P695, New York, NY 10065, USA.
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Kane I, Ragucci D, Shatat IF, Bussel J, Kalpatthi R. Comparison of intravenous immune globulin and high dose anti-D immune globulin as initial therapy for childhood immune thrombocytopenic purpura. Br J Haematol 2010; 149:79-83. [PMID: 20096011 DOI: 10.1111/j.1365-2141.2009.08057.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This report documents our experience with intravenous immune globulin (IVIG) (1 g/kg, iv) and high-dose, anti-D immune globulin (anti-D) (75 microg/kg) as initial treatment for childhood immune thrombocytopenic purpura (ITP). The medical records of children diagnosed with ITP at a single institution between January 2003 and May 2008 were retrospectively reviewed. Participants received either IVIG or high-dose anti-D immune globulin as their initial treatment for ITP. For the 53 patients included for analysis, there was no statistical difference in efficacy between each group; however, patients who received anti-D experienced a higher rate of adverse drug reactions (ADRs), particularly chills and rigours, and 2 of 24 patients in the anti-D group developed severe anaemia requiring medical intervention. Patients who presented with mucosal bleeding had higher rates of treatment failure (32%) compared to those who presented with dry purpura (6%), regardless of treatment. Both IVIG and high-dose anti-D are effective first-line therapies for childhood ITP. However, we observed increased ADRs in the high-dose anti-D group in contrast to previously published reports. Further studies are needed to evaluate safety and premedications for high-dose anti-D and to determine the utility of using the presence of mucosal bleeding to predict treatment failure.
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Affiliation(s)
- Ian Kane
- Department of Pediatrics, MUSC Children's Hospital, Charleston, SC, USA
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18
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Chronic Immune Thrombocytopenia in Children: Epidemiology and Clinical Presentation. Hematol Oncol Clin North Am 2009; 23:1223-38. [DOI: 10.1016/j.hoc.2009.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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19
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International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2009; 115:168-86. [PMID: 19846889 DOI: 10.1182/blood-2009-06-225565] [Citation(s) in RCA: 1219] [Impact Index Per Article: 81.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Previously published guidelines for the diagnosis and management of primary immune thrombocytopenia (ITP) require updating largely due to the introduction of new classes of therapeutic agents, and a greater understanding of the disease pathophysiology. However, treatment-related decisions still remain principally dependent on clinical expertise or patient preference rather than high-quality clinical trial evidence. This consensus document aims to report on new data and provide consensus-based recommendations relating to diagnosis and treatment of ITP in adults, in children, and during pregnancy. The inclusion of summary tables within this document, supported by information tables in the online appendices, is intended to aid in clinical decision making.
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20
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Intracranial hemorrhage (ICH) in children with immune thrombocytopenia (ITP): study of 40 cases. Blood 2009; 114:4777-83. [PMID: 19767509 DOI: 10.1182/blood-2009-04-215525] [Citation(s) in RCA: 142] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Intracranial hemorrhage (ICH) is a rare but devastating complication of childhood immune thrombocytopenia purpura (ITP). A survey of ICH from 1987 to 2000 identified cases of ICH in childhood ITP in the United States. Forty patients with ICH and 80 matched ITP control subjects were accrued. The estimated incidence of ICH was 0.19% to 0.78%. Platelet counts were less than 20 x 10(9)/L in 90% and less than 10 x 10(9)/L in 75% of children with ICH. Eighteen (45%) children developed ICH within 7 days of diagnosis of ITP; for 10 of these, ICH was the presenting feature of ITP. Twelve (30%) children had chronic ITP. Head trauma and hematuria were the most prominent features associated with ICH, identified in 33% and 22.5% of the patients with ICH and 1 and none of the controls (both P < .001). Bleeding beyond petechiae and ecchymoses was also linked to ICH. Mortality was 25%; a further 25% had neurologic sequelae. Strategies by which high-risk children could be identified were considered, and the costs of preventive combination treatment were estimated. Children with severe thrombocytopenia plus head trauma and/or hematuria appeared to be at particularly high risk of ICH. Aggressive treatment of these children may be appropriate.
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21
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Segel GB, Feig SA. Controversies in the diagnosis and management of childhood acute immune thrombocytopenic purpura. Pediatr Blood Cancer 2009; 53:318-24. [PMID: 19165890 DOI: 10.1002/pbc.21934] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Acute immune thrombocytopenic purpura (ITP) occurs most commonly in young children who present with severe isolated thrombocytopenia and purpura. A marrow examination is not required unless glucocorticoids are used, lest treatment mask incipient acute lymphoblastic leukemia, but controversy exists here. The recommendations for evaluation and management remain controversial, since prospective controlled trials have not been done. There is some consensus based on experience and empiric data. Almost all children with acute ITP will recover completely without therapy. Although the various treatments may increase the platelet count, they do not influence the outcome of the illness, may increase cost, and cause significant side effects. Therefore, careful observation may be the best management option for the patient with ITP, in the absence of severe bleeding. The data available relevant to these issues are discussed.
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Affiliation(s)
- George B Segel
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine, Rochester, New York 14642, USA.
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Parodi E, Rivetti E, Amendola G, Bisogno G, Calabrese R, Farruggia P, Giordano P, Rosaria Matarese SM, Nardi M, Nobili B, Notarangelo LD, Russo G, Vimercati C, Zecca M, De Mattia D, Ramenghi U. Long-term follow-up analysis after rituximab therapy in children with refractory symptomatic ITP: identification of factors predictive of a sustained response. Br J Haematol 2009; 144:552-8. [DOI: 10.1111/j.1365-2141.2008.07487.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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