Chronic Lymphocytic Leukemia-associated Refractory Immune Thrombocytopenia Successfully Treated with Eltrombopag

Use of eltrombopag for patients 65 years old or older with immune thrombocytopenia

BACKGROUND

Eltrombopag is useful for immune thrombocytopenia (ITP). However, results of clinical trials may not accurately mirror clinical practice reality. Here we evaluated eltrombopag for primary and secondary ITP in our ≥65-year-old population.

METHODS

A total of 106 primary ITP patients (16 with newly diagnosed ITP, 16 with persistent ITP, and 74 with chronic ITP) and 39 secondary ITP patients (20 with ITP secondary to immune disorders, 7 with ITP secondary to infectious diseases, and 12 with ITP secondary to lymphoproliferative disorders [LPD]) were retrospectively evaluated.

RESULTS

Median age of our cohort was 76 (interquartile range, IQR, 70-81) years. 75.9% of patients yielded a platelet response including 66.2% complete responders. Median time to platelet response was 14 (IQR, 8-21) days. Median time on response was 320 (IQR, 147-526) days. Sixty-three adverse events (AEs), mainly grade 1-2, occurred. The most common were hepatobiliary laboratory abnormalities (HBLAs) and headaches. One transient ischemic attack in a newly diagnosed ITP and two self-limited pulmonary embolisms in secondary ITP were the only thrombotic events observed.

CONCLUSION

Eltrombopag showed efficacy and safety in ITP patients aged ≥65 years with primary and secondary ITP. However, efficacy results in LPD-ITP were poor. A relatively high number of deaths were observed.

Repeated successful use of eltrombopag in chronic primary immune thrombocytopenia: description of an intriguing case

Thrombopoietin receptor agonists (TPO‐RAs) are used as effective alternative treatments in ITP patients unresponsive to first‐/second‐line therapies. TPO‐RAs can also be used to normalize platelet count to safely perform invasive procedures and chemotherapy, in case of malignancies. In few responsive patients, TPO‐RAs can be suspended maintaining a sustained response.

Use of eltrombopag for secondary immune thrombocytopenia in clinical practice

Eltrombopag is a second-line treatment in primary immune thrombocytopenia (ITP). However, its role in secondary ITP is unknown. We evaluated the efficacy and safety of eltrombopag in secondary ITP in daily clinical practice. Eighty-seven secondary ITP patients (46 with ITP secondary to autoimmune syndromes, 23 with ITP secondary to a neoplastic disease subtype: lymphoproliferative disorders [LPDs] and 18 with ITP secondary to viral infections) who had been treated with eltrombopag were retrospectively evaluated. Forty-four patients (38%) had a platelet response, including 40 (35%) with complete responses. Median time to platelet response was 15 days (95% confidence interval, 7-28 days), and was longer in the LPD-ITP group. Platelet response rate was significantly lower in the LPD-ITP than in other groups. However, having achieved response, there were no significant differences between the durable response of the groups. Forty-three patients (49·4%) experienced adverse events (mainly grade 1-2), the commonest being hepatobiliary laboratory abnormalities. There were 10 deaths in this case series, all of which were related to pre-existing medical conditions. In routine clinical practice, eltrombopag is effective and well-tolerated in unselected patients with ITP secondary to both immune and infectious disorders. However, the response rate in LPD-ITP is low.

Variables affecting evaluation and publication of oncology case reports: a systematic analysis

BACKGROUND

Studies on factors affecting editorial decisions of scientific journals are scarce. In this study, we focused on case reports submitted to oncology journals and analyzed whether their nature or other relevant variables affected the chances of their acceptance.

METHODS

We analyzed case reports submitted to 2 oncology journals: Tumori Journal and The International Journal of Biological Markers, and split them into 3 predefined groups: those (a) describing rare or unusual presentation of diseases, (b) describing the side effects of an intervention or (c) describing the success of a novel intervention. Publication status was retrospectively retrieved from the submission system, and acceptance rates were calculated taking into account other variables including geographic location of corresponding author.

RESULTS

A total of 326 case reports were suitable for analysis. The acceptance rate was 35.4% for group (a), 27.9% for group (b), 19.6% for group (c) (p = 0.01). After correcting for other variables, the odds ratio (OR) of being accepted for group (c) was 0.58 (95% CI, 0.33-1.00) compared with the other groups combined. There was a highly significant difference of acceptance rates between manuscripts with authors coming from developed vs. developing countries that remained significant (OR = 5.94; 95% CI, 3.05-10.09) after correcting for multiple variables.

CONCLUSIONS

The nature of a case report in oncology may affect acceptance rate, with case reports describing successful approaches or side effects of treatment being accepted with a higher frequency then case reports describing a rare clinical or diagnostic scenario. Also, works coming from developed countries are accepted significantly more frequently than case reports coming from developing countries.