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Žibřidová K, Souček O, Krčmová LK, Jankovičová K, Gančarčíková M, Pejková MA, Drugda J, Nováková D, Košťál M. Lymphocyte subpopulations: a potential predictor of a response in patients with immune thrombocytopenia. Hematology 2024; 29:2304486. [PMID: 38251842 DOI: 10.1080/16078454.2024.2304486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVES Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder caused by increased platelet destruction and altered production. Despite the well-described pathophysiological background of immune dysregulation, current treatment guidelines consist of monotherapy with different drugs, with no tool to predict which patient is more suitable for each therapeutic modality. METHODS In our study, we attempted to determine differences in the immune setting, comparing the patients' responses to administered therapy. During 12-month follow-up, we assessed blood count, antiplatelet autoantibodies, and T lymphocyte subsets in peripheral blood in 35 patients with ITP (newly diagnosed or relapsed disease). RESULTS Our data show that the value of antiplatelet autoantibodies, the percentage of cytotoxic T lymphocytes, and the immunoregulatory index (IRI, CD4+ / CD8+ T cell ratio) differ significantly by treatment response. Responders have a higher IRI (median 2.1 vs. 1.5 in non-responders, P = 0.04), higher antiplatelet autoantibodies (median 58 vs. 20% in non-responders, P = 0.01) and lower relative CD8+ T cells count (P = 0.02) before treatment. DISCUSSION The results suggest that immunological parameters (antiplatelet autoantibodies, relative CD8+ T cell count and IRI) could be used as prognostic tools for a worse clinical outcome in patients with ITP. CONCLUSION These biomarkers could be utilized for stratification and eventually selection of treatment preferring combination therapy.
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Affiliation(s)
- Kateřina Žibřidová
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
- Academic Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Ondřej Souček
- Department of Clinical Immunology and Allergology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
- Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Lenka Kujovská Krčmová
- Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Karolína Jankovičová
- Department of Clinical Immunology and Allergology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
- Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Markéta Gančarčíková
- Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Mária Anna Pejková
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
- Academic Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Jan Drugda
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
- Academic Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Denisa Nováková
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
- Academic Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Milan Košťál
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
- Academic Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
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Fu H, Cai X, Cui L, Nong W, Li W, Mei H, Yang T, Yue H, Huang Q, An Z, Wu Y, Huang X, Zhang X. The evolution of preexisting primary immune thrombocytopenia after COVID-19 onset: A nationally representative, prospective, multicentre, observational study. Ann Hematol 2024; 103:1549-1559. [PMID: 38526649 DOI: 10.1007/s00277-024-05720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Abstract
The symptoms in patients with primary immune thrombocytopenia (ITP) after COVID-19 onset remain largely unclear. The aim of this study was to describe the platelet count fluctuations in ITP patients following the diagnosis of COVID-19. A prospective multicentre observational study was conducted from December 15th, 2022, to January 31st, 2023 in 39 general hospitals across China. Patients with preexisting primary ITP who were newly diagnosed with COVID-19 were enrolled. A total of 1216 ITP patients with newly-diagnosed COVID-19 were enrolled. 375 (30.8%) patients experienced ITP exacerbation within eight weeks after the diagnosis of COVID-19, and most exacerbation (266/375, 70.9%) developed in the first two weeks. Immunosuppressive therapy for ITP and severe/critical COVID-19 infection were independent variables associated with ITP exacerbation. Overall the platelet count had a transient increasing trend, and the platelet peak value occurred at two weeks after COVID-19 infection. Then, the platelet count decreased to the baseline level in the following weeks. The platelet count had a transient increasing trend in ITP patients following the diagnosis of COVID-19. ITP exacerbation only occurred in less than one-third of ITP patients. Nonimmunosuppressive therapy may have an advantage to prevent ITP exacerbation during COVID-19.
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Affiliation(s)
- Haixia Fu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, China
| | - Xuan Cai
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, China
| | - Lijuan Cui
- General Hospital of Ningxia Medical University, Lan Zhou, Ningxia, China
| | - Weixia Nong
- Department of Hematology, First Affiliated Hospital, School of Medicine, Shihezi University, Xinjiang, China
| | - Wenqian Li
- Department of Hematology, Qinghai Provincial People's Hospital, Xining, Qinghai, China
| | - Heng Mei
- Institute of Hematology, Union Hospital, Tonggji Medical Colloege, Huazhong University of Science and Technology, Wuhan, China
| | - Tonghua Yang
- Department of Hematology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Han Yue
- Department of Hematology, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Qiusha Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, China
| | - Zhuoyu An
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, China
| | - Yejun Wu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, China
| | - Xiaojun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, China
| | - Xiaohui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, China.
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Nilforoushzadeh MA, Heidari N, Heidari A, Ghane Y, Lotfi Z, Jaffary F, Najar Nobari M, Najar Nobari N. The role of BAFF and BAFF-R inhibitors in the treatment of immune thrombocytopenia; a focused review. Int Immunopharmacol 2024; 131:111827. [PMID: 38460303 DOI: 10.1016/j.intimp.2024.111827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/02/2024] [Accepted: 03/06/2024] [Indexed: 03/11/2024]
Abstract
Immune thrombocytopenia (ITP) is an autoimmune-driven disease characterized by increased destruction and impaired platelet production resulting in an enhanced risk of bleeding. Immunosuppressant agents are the most common treatment strategies for ITP. Despite their efficacy, these medications often cause unpredictable side effects. Recent investigations revealed that patients with ITP exhibit elevated B-cell activating factor (BAFF) levels in both their spleens and serum. Belimumab, a BAFF inhibitor, illustrated a promising therapeutic avenue for managing ITP by interfering with BAFF activity and long-lived plasma cell production. Both clinical and experimental studies have yielded positive outcomes when combining rituximab with an anti-BAFF monoclonal antibody in treating ITP. In addition, ianalumab, a monoclonal antibody with a dual mechanism that targets BAFF-R and deletes peripheral BAFF-R+ B cells, is currently being used for ITP treatment [NCT05885555]. The upcoming results from novel BAFF inhibitors, such as ianalumab, could offer clinicians an additional therapeutic option for treating ITP.
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Affiliation(s)
- Mohammad Ali Nilforoushzadeh
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nazila Heidari
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran; School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Amirhossein Heidari
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran; Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
| | - Yekta Ghane
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Lotfi
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fariba Jaffary
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Minou Najar Nobari
- Department of Orofacial Pain and Dysfunction, UCLA School of Dentistry, Los Angeles, CA, USA.
| | - Niloufar Najar Nobari
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Ciftciler R, Ciftciler AE, Yıldırımel C. Evaluation of vitamin D status in adult patients with newly diagnosed immune thrombocytopenia. J Investig Med 2024; 72:326-332. [PMID: 38373911 DOI: 10.1177/10815589241235660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
It has been shown that 25-OH vitamin D not only preserves calcium and bone homeostasis but also has immunomodulatory effects. The purpose of this study was to assess the association between adult patients with recently diagnosed immune thrombocytopenia (ITP) and vitamin D levels. Retrospective technique was employed in this study. The associations between 25(OH)D value and platelet count, as well as the clinical symptoms of ITP upon diagnosis and 25(OH)D value, were our main findings. A total of 60 patients diagnosed and followed up in our clinic were included in the study. Forty-one patients (68.3%) were female and 19 (31.7%) were male. The median age of the patients was 52.5 (19-88). The median vitamin D level of all patients at diagnosis of ITP was 11.5 (3-86). There was no statistically significant difference between the patients divided into three groups according to their vitamin D levels, in terms of laboratory parameters. There was no statistically significant difference in clinical findings according to vitamin D status in ITP patients. There was no statistically significant difference in terms of relapse-free survival in all three groups (p = 0.71). In conclusion, in our study, no correlation was found between laboratory and clinical findings at diagnosis and vitamin D levels in adult ITP patients. Additional investigations, particularly randomized controlled trials, are required to examine the relationship between 25(OH)D and the incidence and severity of ITP.
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Affiliation(s)
- Rafiye Ciftciler
- Faculty of Medicine, Department of Hematology, Selcuk University, Konya, Turkey
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Liang Y, Rascati K, Barner JC, Lawson KA, Nair R. Treatment patterns and outcomes among adults with immune thrombocytopenia receiving pharmaceutical second-line therapies: a retrospective cohort study using administrative claims data. Curr Med Res Opin 2024:1-8. [PMID: 38465414 DOI: 10.1080/03007995.2024.2328653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVES To describe and compare real-world treatment patterns and clinical outcomes among individuals with immune thrombocytopenia (ITP) receiving second-line therapies (rituximab, romiplostim, or eltrombopag). METHODS A retrospective cohort study was conducted using a large administrative claims database (January 2013-May 2020) among continuously enrolled patients ≥18 years prescribed second-line ITP therapies. The index date was the date of the first claim of the study medications. Treatment patterns and outcomes were measured during the 12-month follow-up period. Inverse probability of treatment weighting (IPTW) was used to balance covariates across treatment groups. Multivariable logistic regression was used to compare treatment patterns and bleeding risk outcomes. RESULTS A total of 695 patients were included (rituximab, N = 285; romiplostim, N = 212; eltrombopag, N = 198). After IPTW, all baseline covariates were balanced. Compared to eltrombopag, patients in the rituximab cohort were 57% more likely to receive other ITP therapies (systematic corticosteroids or third-line therapies) during the follow-up period (odds ratio [OR] = 1.571, p = .030). There was no significant difference in the odds of receiving a different second-line therapy or experiencing a bleeding-related episode among three groups (p > .050). Patients in the romiplostim cohort were 69% more likely to receive rescue therapy compared to those in the rituximab cohort (OR = 1.688, p = .025). CONCLUSION Patients with ITP receiving rituximab were more likely to need other ITP therapies but did not experience higher risk of bleeding compared to those receiving eltrombopag or romiplostim. Benefits, risks, cost-effectiveness, and patient preference should all be considered in optimizing second-line therapy for ITP.
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Affiliation(s)
- Yi Liang
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Karen Rascati
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
- TxCORE - Texas Center for Health Outcomes Research and Education, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Jamie C Barner
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
- TxCORE - Texas Center for Health Outcomes Research and Education, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Kenneth A Lawson
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
- TxCORE - Texas Center for Health Outcomes Research and Education, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
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Wang X, Wang L, Li A, Xin Y. Cerebral venous thrombosis in a pediatric patient undergoing multi-drug therapy for chronic primary immune thrombocytopenia: A case report and interview. Asian J Surg 2024:S1015-9584(24)00503-7. [PMID: 38522981 DOI: 10.1016/j.asjsur.2024.03.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/14/2024] [Indexed: 03/26/2024] Open
Affiliation(s)
- Xiaoli Wang
- Department of Pediatric, Yantai Yu Huang Ding Hospital, Yantai, 264000, Shandong, China
| | - Li Wang
- Department of Pediatric, Yantai Yu Huang Ding Hospital, Yantai, 264000, Shandong, China
| | - Aimin Li
- Department of Pediatric, Yantai Yu Huang Ding Hospital, Yantai, 264000, Shandong, China
| | - Yi Xin
- Department of Pediatric, Yantai Yu Huang Ding Hospital, Yantai, 264000, Shandong, China.
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Moore DC, Elmes JB, Arnall JR, Strassel SA, Patel JN. PD-1/PD-L1 inhibitor-induced immune thrombocytopenia: A pharmacovigilance study and systematic review. Int Immunopharmacol 2024; 129:111606. [PMID: 38359661 DOI: 10.1016/j.intimp.2024.111606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Programmed cell death-1 (PD-1) and programmed cell death ligand-1 (PD-L1) immune checkpoint inhibitors (ICIs) are used for a variety of cancers and are associated with a risk of developing immune-related adverse events, most commonly dermatitis, colitis, hepatitis, and pneumonitis. Immune-mediated hematologic toxicities have been reported, but are less well-described in the literature. Immune thrombocytopenia (ITP) is a rare autoimmune, hematologic adverse event that has been reported with PD-1/PD-L1 inhibitors. METHODS We performed a retrospective observational analysis of the United States Food and Drug Administration Adverse Event Reporting System (FAERS) data. We searched for cases of ITP reported with exposure to PD-1/PD-L1 inhibitors from initial FDA approval for each agent to September 30, 2022. Disproportionality signal analysis was done by calculating the reporting odds ratio (ROR). Oxaliplatin was used as a positive control for sensitivity analysis as it is an anticancer therapy that has been associated with drug-induced ITP. A systematic review of the PubMed database was also conducted to identify published cases of PD-1/PD-L1 inhibitor-induced ITP. RESULTS There were 329 reports of ITP with ICIs in the FAERS database that were reviewed for a disproportionality signal, including atezolizumab (n = 27), durvalumab (n = 17), nivolumab (n = 160), and pembrolizumab (n = 125). The ROR was significant for atezolizumab (ROR 5.39, 95 % CI 3.69-7.87), avelumab (ROR 10.32, 95 % CI 4.91-21.69), durvalumab (ROR 7.91, 95 % CI 4.91-12.75), nivolumab (ROR 9.76, 95 % CI 8.34-11.43), and pembrolizumab (ROR 12.6, 95 % CI 10.55-15.06). In our systematic review, we summated 57 cases of ICI-induced ITP. Nivolumab and pembrolizumab had the most reported cases of ITP in the literature. Most cases reported (53 %) included ITP-directed therapies beyond corticosteroids for the management of ICI-induced ITP. CONCLUSION There is a significant reporting signal of ITP with several ICI agents. Clinicians should be aware of and monitor for signs of this potentially serious adverse event.
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Affiliation(s)
- Donald C Moore
- Clinical Oncology Pharmacy Manager, Levine Cancer Institute, Atrium Health, Department of Pharmacy, 1021 Morehead Medical Drive, Charlotte, NC 28204, USA.
| | - Joseph B Elmes
- Oncology Clinical Staff Pharmacist, Levine Cancer Institute, Atrium Health, Department of Pharmacy, 100 Medical Park Drive, Concord, NC 28025, USA.
| | - Justin R Arnall
- Pharmacist Clinical Coordinator - Hematology/Hemophilia, Atrium Health, Specialty Pharmacy Service, 4400 Golf Acres Drive, Charlotte, NC 28208, USA.
| | - Scott A Strassel
- Atrium Health, Department of Pharmacy, 4400 Golf Acres Drive, Charlotte, NC 28232, USA.
| | - Jai N Patel
- Clinical Pharmacology and Pharmacogenomics, Levine Cancer Institute, Atrium Health, Department of Cancer Pharmacology and Pharmacogenomics, 1021 Morehead Medical Drive, Charlotte, NC 28204, USA.
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El Demerdash DM, Saber MM, Ayad A, Gomaa K, Abdelkader Morad M. Cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) gene polymorphisms in a cohort of Egyptian patients with immune thrombocytopenia (ITP). Blood Res 2024; 59:8. [PMID: 38485815 PMCID: PMC10917709 DOI: 10.1007/s44313-024-00011-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/05/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Immune thrombocytopenia (ITP) is characterized by immune response dysregulations. Cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) plays a central role in immune checkpoint pathways and preventing autoimmune diseases by regulating immune tolerance. We aimed to explore the potential association between CTLA-4 gene polymorphisms and ITP as well as study their impact on the response to therapy. METHODS We investigated two CTLA-4 single-nucleotide polymorphisms (SNPs; rs: 231775 and rs: 3087243) using real-time PCR as well as the plasma levels of CTLA-4 by ELISA in 88 patients with ITP and 44 healthy participants (HC). RESULTS CTLA-4 (rs: 3087243) A > G polymorphism analysis showed most HC had the homozygous AA genotype, which was statistically significant compared to patients with ITP. Plasma levels of CTLA4 were statistically lower in patients with acute ITP. There was no correlation between CTLA-4 (rs: 231775 and rs: 3087243) A/G SNPs were not correlated to the response to all lines of therapy assessed (corticosteroids, thrombopoietin receptor agonists, splenectomy, and rituximab). CONCLUSION CTLA-4 CT 60 A/G may affect the susceptibility of ITP, but both CTLA-4 + 49 A/G and CT60 A/G did not impact the response of patients with ITP to different lines of therapy.
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Affiliation(s)
- Doaa Mohamed El Demerdash
- Internal Medicine Department, Faculty of Medicine, Teaching Kasr AL-Ainy Hospital, Cairo University, Al Kasr Al Aini, Old Cairo, 4240310, Cairo Governorate, Egypt.
| | - Maha Mohamed Saber
- Internal Medicine Department, Faculty of Medicine, Teaching Kasr AL-Ainy Hospital, Cairo University, Al Kasr Al Aini, Old Cairo, 4240310, Cairo Governorate, Egypt
| | - Alia Ayad
- Internal Medicine Department, Faculty of Medicine, Teaching Kasr AL-Ainy Hospital, Cairo University, Al Kasr Al Aini, Old Cairo, 4240310, Cairo Governorate, Egypt
| | - Kareeman Gomaa
- Clinical and Chemical Pathology Department, Faculty of Medicine, Kasr AL-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Mohamed Abdelkader Morad
- Internal Medicine Department, Faculty of Medicine, Teaching Kasr AL-Ainy Hospital, Cairo University, Al Kasr Al Aini, Old Cairo, 4240310, Cairo Governorate, Egypt
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Dong S, Wang Z, Wang N, Ma J, Meng J, Sun Y, Cheng X, Wu R. Spotlight on eltrombopag concentration in pediatric immune thrombocytopenia: A single-center observational study in China. Pediatr Investig 2024; 8:44-52. [PMID: 38516133 PMCID: PMC10951492 DOI: 10.1002/ped4.12411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/18/2023] [Indexed: 03/23/2024] Open
Abstract
Importance Eltrombopag has been recommended for pediatric immune thrombocytopenia (ITP). Response and adverse drug reactions (ADRs) varied widely between individuals, even at the same dose of eltrombopag. The appropriate eltrombopag concentration in ITP has not been reported. Objective This study aims to explore the appropriate eltrombopag concentration in pediatric ITP. Methods This was a single-center, prospective cohort study. Children diagnosed with refractory persistent/chronic ITP and platelet count < 30×109/L were treated with eltrombopag and followed up for at least 2 months. Concentration was detected by high-performance liquid chromatography-mass spectrometry at least 2 weeks after eltrombopag. The clinical characteristics-concentration, concentration-response, and concentration-ADRs were analyzed. Results A total of 30 patients were enrolled, comprising 13 males and 17 females, with a median age of 72 (45‒94) months. The median dose and concentration were 1.39 (1.09‒1.56) mg/kg and 2.70 (2.25‒4.13) mg/L, respectively. Of the enrolled patients, 14 responded to treatment, whereas 16 did not. Additionally, five experienced adverse drug reactions. No linear correlation was observed between eltrombopag concentration and clinical characteristics. The concentration was lower in the response group than in the nonresponse group, but there was no significant difference (t = 0.755, P = 0.457). Patients who experienced ADRs had a higher concentration than those without ADRs (t = 2.538, P = 0.017). The area under the receiver operating characteristic curve of ADRs was 0.78 (95% confidence interval: 0.56‒1.00). Youden's index identified the cutoff point as 4.33 mg/L, with a sensitivity of 88% and a specificity of 60%. Logistic regression analysis demonstrated that a higher platelet count before eltrombopag predicted a favorable response. Interpretation Eltrombopag proves efficacious and well-tolerated for treating pediatric ITP. However, prolonged and high-dose administration may increase the likelihood of ADRs. Thus, examining the appropriate eltrombopag concentration assists in directing individualized management of pediatric ITP.
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Affiliation(s)
- Shuyue Dong
- Hematology Oncology CenterBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Zhifa Wang
- Hematology Oncology CenterBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Nan Wang
- Department of PharmacyBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Jingyao Ma
- Hematology Oncology CenterBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Jinxi Meng
- Hematology Oncology CenterBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Yixin Sun
- Department of PharmacyBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Xiaoling Cheng
- Department of PharmacyBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Runhui Wu
- Hematology Oncology CenterBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
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Delshad M, Davoodi-Moghaddam Z, Pourbagheri-Sigaroodi A, Faranoush M, Abolghasemi H, Bashash D. Translating mechanisms into therapeutic strategies for immune thrombocytopenia (ITP): Lessons from clinical trials. Thromb Res 2024; 235:125-147. [PMID: 38335568 DOI: 10.1016/j.thromres.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Abstract
Immune thrombocytopenia (ITP) is an autoimmune disorder that causes a significant reduction in peripheral blood platelet count. Fortunately, due to an increased understanding of ITP, there have been significant improvements in the diagnosis and treatment of these patients. Over the past decade, there have been a variety of proven therapeutic options available for ITP patients, including intravenous immunoglobulins (IVIG), Rituximab, corticosteroids, and thrombopoietin receptor agonists (TPO-RAs). Although the effectiveness of current therapies in treating more than two-thirds of patients, still some patients do not respond well to conventional therapies or fail to achieve long-term remission. Recently, a significant advancement has been made in identifying various mechanisms involved in the pathogenesis of ITP, leading to the development of novel treatments targeting these pathways. It seems that new agents that target plasma cells, Bruton tyrosine kinase, FcRn, platelet desialylation, splenic tyrosine kinase, and classical complement pathways are opening new ways to treat ITP. In this study, we reviewed the pathophysiology of ITP and summarized updates in this population's management and treatment options. We also took a closer look at the 315 ongoing trials to investigate their progress status and compare the effectiveness of interventions. May our comprehensive view of ongoing clinical trials serve as a guiding beacon, illuminating the path towards future trials of different drugs in the treatment of ITP patients.
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Affiliation(s)
- Mahda Delshad
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Laboratory Sciences, School of Allied Medical Sciences, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Zeinab Davoodi-Moghaddam
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atieh Pourbagheri-Sigaroodi
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Faranoush
- Pediatric Growth and Development Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Abolghasemi
- Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Bashash
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Britto J, Holbrook A, Sun H, Cserti-Gazdewich C, Prokopchuk-Gauk O, Hsia C, Khamisa K, Yenson PR, Sholzberg M, Olney HJ, Shivakumar S, Jones D, Merkeley H, Costello J, Jamula E, Arnold DM. Thrombopoietin Receptor Agonists and Other Second-Line Therapies for Immune Thrombocytopenia: A Narrative Review With a Focus on Drug Access in Canada. CLIN INVEST MED 2024; 47:13-22. [PMID: 38546381 DOI: 10.3138/cim-2024-2569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Immune thrombocytopenia (ITP) is an autoimmune disease characterized by low platelet counts and increased risk of bleeding. After corticosteroids with or without intravenous immune globulin (first-line treatment), second-line treatment options include rituximab, splenectomy, thrombopoietin receptor agonists (TPO-RAs), and fostamatinib. In Canada, the choice of second-line therapy is influenced by access to medications. The goals of this narrative review are to 1) summarize the evidence for the use of TPO-RAs and other second-line therapies in ITP and 2) highlight differences in public funding criteria for TPO-RAs across provinces and territories in Canada. METHODS We conducted a literature review of second-line therapies for ITP. We solicited information on public funding programs for TPO-RAs in Canada from health care providers, pharmacists, and provincial ministries of health. RESULTS Head-to-head trials involving TPO-RAs, rituximab, splenectomy, and fostamatinib are lacking. There is substantial evidence of effect for TPO-RAs in improving platelet count levels, health-related quality of life, bleeding, and fatigue from placebo-controlled trials and observational studies; however, access to TPO-RAs through provincial funding programs in Canada is variable. Splenectomy failure is a prerequisite for the funding of TPO-RAs in Ontario, Manitoba, and Saskatchewan, but not in Alberta or Quebec. Other provinces either do not have access to public funding or funding is provided on a case-by-case basis. DISCUSSION TPO-RAs are effective second-line therapies for the treatment of ITP; however, access is variable across Canada, which results in health disparities and poor uptake of international treatment guidelines.
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Affiliation(s)
- Joanne Britto
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anne Holbrook
- Department of Medicine, Division of Clinical Pharmacology and Toxicology, McMaster University, Hamilton, Ontario, Canada
| | - Haowei Sun
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Christine Cserti-Gazdewich
- Department of Medicine/Division of Hematology, University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Oksana Prokopchuk-Gauk
- Department of Pathology and Lab Medicine, University of Saskatchewan, Saskatchewan Health Authority, Canada
| | - Cyrus Hsia
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Karima Khamisa
- Division of Hematology, Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Paul R Yenson
- Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michelle Sholzberg
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Harold J Olney
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Sudeep Shivakumar
- Division of Hematology, Nova Scotia Health Authority, Halifax, NS, Canada
| | - David Jones
- Department of Hematology, Eastern Health, Memorial University, Newfoundland & Labrador, Canada
| | - Hayley Merkeley
- Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jacqueline Costello
- Department of Hematology, Eastern Health, Memorial University, Newfoundland & Labrador, Canada
| | - Erin Jamula
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Donald M Arnold
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
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12
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Cornudella Lema J, Sánchez-González B, Carrión-Barberà I, Vázquez Montes de Oca S, García Pallarols F, Salman-Monte TC. Immune thrombocytopenia in systemic lupus erythematosus: Prevalence, risk factors, and a novel predictive model for risk assessment. Med Clin (Barc) 2024:S0025-7753(24)00029-0. [PMID: 38383267 DOI: 10.1016/j.medcli.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Immune thrombocytopenia (ITP) is a potentially severe manifestation of systemic lupus erythematosus (SLE) reported in 7-40% of SLE patients. ITP has been associated with a higher risk of organ damage and mortality. OBJECTIVES To describe which factors are associated with the presence of ITP in SLE patients. METHODS Retrospective case-control study. Cases were defined as SLE patients who had ever developed ITP and were sex- and age-matched with two controls. A predictive model was constructed to identify SLE patients who were at risk of developing ITP. RESULTS ITP prevalence in our SLE cohort was 8.35%. Cases had a higher frequency of hemolytic anemia, while controls had a higher prevalence of arthritis at SLE diagnosis. During SLE progression, cases tested positive for anticardiolipin, anti-β2-glycoprotein 1, and lupus anticoagulant antibodies more frequently. Cases received mycophenolic acid and azathioprine more often than controls and had a higher SLICC/ACR score. The model demonstrated a sensitivity of 87.53%, a positive predictive value of 81.92%, a specificity of 80.50%, area under the curve of 83.92%, a F1 of 83% and an overall accuracy of 83.68%. The variables that best explain the model were hemolytic anemia, arthritis, oral ulcers, Raynaud's phenomenon, low C4, low CH50, anticardiolipin and anti-β2GP1 antibodies. CONCLUSION SLE patients who develop ITP have a distinct phenotype characterized by more hemolytic anemia and less arthritis at SLE onset, and higher prevalence of antiphospholipid syndrome antibodies during SLE progression. This phenotype is associated with heightened organ damage and the need for more intensive therapies and stricter follow-up. Our predictive model has demonstrated an impressive ability to identify SLE patients at risk of developing ITP.
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Affiliation(s)
| | - Blanca Sánchez-González
- Department of Hematology, Hospital del Mar, Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, Spain; Hospital del Mar Autoimmune Diseases and Vasculitis Unit of Excellence Unit Disease, Spain
| | - Irene Carrión-Barberà
- Hospital del Mar Research Institute, Barcelona, Spain; Hospital del Mar Autoimmune Diseases and Vasculitis Unit of Excellence Unit Disease, Spain; Department of Rheumatology, Hospital del Mar, Barcelona, Spain.
| | | | - Francesc García Pallarols
- Department of Hematology, Hospital del Mar, Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, Spain
| | - Tarek Carlos Salman-Monte
- Hospital del Mar Research Institute, Barcelona, Spain; Hospital del Mar Autoimmune Diseases and Vasculitis Unit of Excellence Unit Disease, Spain; Department of Rheumatology, Hospital del Mar, Barcelona, Spain
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13
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Liu LY, Zhang B, Song CD, Li PF, Yang M, Ren XQ, Ding Y. Successful treatment with oseltamivir phosphate in children with ITP who failed first-line therapy: a case series report. Ann Hematol 2024; 103:405-408. [PMID: 38095655 DOI: 10.1007/s00277-023-05581-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024]
Abstract
Immune thrombocytopenia (ITP) is a common bleeding disorder in children. First-line medicines (glucocorticoids and immunoglobulin) may not be effective for some children, endangering their lives, posing challenges for healthcare facilities, and leading to an unfavorable prognosis. As a sialidase inhibitor, oseltamivir phosphate can reduce the destruction of platelets in liver macrophages by inhibiting the sialylation of platelets, and finally achieve the purpose of increasing platelet count. In this paper, three cases of children with ITP who failed first-line therapy and were cured by oral administration of oseltamivir phosphate granules were reported. The mechanism of action of oseltamivir phosphate granules was clarified.
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Affiliation(s)
- Li-Ya Liu
- The First Affiliated Hospital of Henan University of Chinese Medicine, Henan, China
- School of Pediatrics, Henan University of Chinese Medicine, Henan, China
| | - Bo Zhang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Henan, China
- School of Pediatrics, Henan University of Chinese Medicine, Henan, China
| | - Chun-Dong Song
- The First Affiliated Hospital of Henan University of Chinese Medicine, Henan, China
- School of Pediatrics, Henan University of Chinese Medicine, Henan, China
| | - Peng-Fei Li
- The First Affiliated Hospital of Henan University of Chinese Medicine, Henan, China
- School of Pediatrics, Henan University of Chinese Medicine, Henan, China
| | - Meng Yang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Henan, China
- School of Pediatrics, Henan University of Chinese Medicine, Henan, China
| | - Xian-Qing Ren
- The First Affiliated Hospital of Henan University of Chinese Medicine, Henan, China
- School of Pediatrics, Henan University of Chinese Medicine, Henan, China
| | - Ying Ding
- The First Affiliated Hospital of Henan University of Chinese Medicine, Henan, China.
- School of Pediatrics, Henan University of Chinese Medicine, Henan, China.
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Chaudhry M, Stadler JK, Fitzgerald K, Modi J, Jones G, Magana K, Ward S, Magee T, Hughes G, Ford AI, Vassar M. Assessing uptake of the core outcome set in clinical trials for immune thrombocytopenia: A cross-sectional analysis. Thromb Res 2024; 234:113-119. [PMID: 38211379 DOI: 10.1016/j.thromres.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Clinical trials (CTs) guide clinical practice, but inconsistent outcome reporting presents challenges. To increase comparability, a core outcome set (COS) was created for primary Immune thrombocytopenia (ITP) in 2009 to standardize outcome measurements. We aimed to evaluate uptake of the primary ITP COS in CT registries. MATERIALS & METHODS Our cross-sectional analysis employed a search string on ClinicalTrials.gov and ICTRP for phase III/IV CTs in June 2023. Inclusion criteria consisted of subjects with primary ITP, study was registered five years before COS publication to June 26, 2023, and assessed effectiveness of interventions. Two investigators extracted data in a masked, duplicate manner. Interrupted time series analysis, ANOVAs, and correlation analyses were conducted to assess the main outcome of COS uptake pre/post COS publication. RESULTS The search identified 131 eligible trials for data extraction. Altogether, 38.2 % (50/131) followed IWG platelet response guidelines. An alternative platelet count measurement was 50,000 × 109 L, with 46.56 % (61/131) of trials reporting it. The most measured outcome was adverse events (106/131, 80.9 %). Remaining secondary outcomes were measured in <50 % of studies. After COS publication, there was a statistically non-significant 0.03 % (p = 0.50, CI 95 % = [-0.06, 0.13]) 0.03 % (p = 0.50, CI 95 % = [-0.06, 0.13]) increase in the monthly trend of COS-defined outcomes. CONCLUSION We found a non-significant increase in uptake of the ITP COS since its publication and highlighted the lack of standardization among endpoints within ITP clinical trials. Our analysis highlights the need for heightened awareness and a COS update that acknowledges the variability in clinical trials.
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Affiliation(s)
- Mahad Chaudhry
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States.
| | - John K Stadler
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Kyle Fitzgerald
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Jay Modi
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Garrett Jones
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Kimberly Magana
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Shaelyn Ward
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Trevor Magee
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Griffin Hughes
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Alicia Ito Ford
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
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15
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Mu F, Bai X, Lou Y, Luo P, Guo Q. Rituximab alleviates pediatric systemic lupus erythematosus associated refractory immune thrombocytopenia: a case-based review. Immunol Res 2024:10.1007/s12026-024-09454-z. [PMID: 38279058 DOI: 10.1007/s12026-024-09454-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/10/2024] [Indexed: 01/28/2024]
Abstract
A complication of pediatric systemic lupus erythematosus (pSLE) is immune thrombocytopenia (ITP). Although corticosteroids and immunoglobulins are frequently used as preliminary treatments, some patients do not respond to them. Rituximab has been reported to be safe and effective in the treatment of pSLE complicated with refractory ITP. Research is currently underway to determine the optimal rituximab dose for these individuals. We report a case of a child with SLE-associated ITP (SLE-ITP) who was successfully treated with rituximab. Rituximab is likely the most viable therapeutic option for refractory SLE-ITP. Furthermore, a comprehensive review of the relevant literature was performed and a concise overview of the pathogenesis and available treatment modalities for pediatric patients diagnosed with SLE and concurrent ITP was provided.
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Affiliation(s)
- Fangxin Mu
- Department of Nephrology and Rheumatology, The Second Hospital of Jilin University, Changchun, Jilin, 130041, China
| | - Xue Bai
- Department of Nephrology and Rheumatology, The Second Hospital of Jilin University, Changchun, Jilin, 130041, China
| | - Yan Lou
- Department of Nephrology and Rheumatology, The Second Hospital of Jilin University, Changchun, Jilin, 130041, China
| | - Ping Luo
- Department of Nephrology and Rheumatology, The Second Hospital of Jilin University, Changchun, Jilin, 130041, China
| | - Qiaoyan Guo
- Department of Nephrology and Rheumatology, The Second Hospital of Jilin University, Changchun, Jilin, 130041, China.
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Sirotich E, Nazaryan H, Chowdhury SR, Guyatt G, Agarwal A, Leong R, Wen A, Xu E, Liu B, Pallapothu S, Rathod P, Kwon HY, Dookie J, Shafiee A, Charness J, DiRaimo J, Paynter D, Pruitt B, Strachan G, Couban R, Ye Z, Arnold DM. Treatment of critical bleeding events in patients with immune thrombocytopenia: a protocol for a systematic review and meta-analysis. Syst Rev 2024; 13:21. [PMID: 38184622 PMCID: PMC10770981 DOI: 10.1186/s13643-023-02436-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 12/13/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Critical bleeding events in adults and children with ITP are medical emergencies; however, evidence-based treatment protocols are lacking. Due to the severe thrombocytopenia, (typically platelet count less than 20 × 109/L), a critical bleed portends a high risk of death or disability. We plan to perform a systematic review and meta-analysis of treatments for critical bleeding in patients with ITP that will inform evidence-based recommendations. METHODS Literature searches will be conducted in four electronic databases: Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed. Eligible studies will be randomized controlled trials or observational studies that enrolled patients with ITP describing one or more interventions for the management of critical bleeding. Title and abstract screening, full-text screening, data extraction, and risk of bias evaluation will be conducted independently and in duplicate using Covidence and Excel. Outcomes will be pooled for meta-analysis where appropriate or summarized descriptively. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology will be used to evaluate the certainty of the evidence. Primary outcomes of interest will include frequency of critical bleeds, mortality and bleeding-related mortality, bleeding resolution, platelet count, and disability. DISCUSSION Evidence-based treatments for critical bleeding in patients with ITP are needed to improve patient outcomes and standardize care in the emergency setting. SYSTEMATIC REVIEW REGISTRATION CRD42020161206.
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Affiliation(s)
- Emily Sirotich
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Hasmik Nazaryan
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Saifur Rahman Chowdhury
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Arnav Agarwal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Russell Leong
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Aaron Wen
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Emily Xu
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Bonnie Liu
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Sushmitha Pallapothu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Preksha Rathod
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Henry Y Kwon
- Department of Surgery, Henry Ford Health Systems, Detroit, MI, USA
| | - Jared Dookie
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Amirmohammad Shafiee
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Jay Charness
- Platelet Disorder Support Association (PDSA), Cleveland, OH, USA
| | - Jennifer DiRaimo
- Platelet Disorder Support Association (PDSA), Cleveland, OH, USA
| | - Dale Paynter
- Platelet Disorder Support Association (PDSA), Cleveland, OH, USA
| | - Barbara Pruitt
- Platelet Disorder Support Association (PDSA), Cleveland, OH, USA
| | - Gail Strachan
- Platelet Disorder Support Association (PDSA), Cleveland, OH, USA
| | - Rachel Couban
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Zhikang Ye
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Donald M Arnold
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.
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Li H, Xin Q, Hong L, Hu Y, Lin L, Guo M, Jiang H, He C, Wang S, Li M. Mendelian randomization analysis reveals causality of inflammatory bowel disease on risks of Henoch-Schönlein purpura and immune thrombocytopenia. Dig Liver Dis 2024; 56:92-97. [PMID: 37659917 DOI: 10.1016/j.dld.2023.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Emerging clinical evidence has been discovered associating Inflammatory bowel disease (IBD) with Henoch-Schönlein purpura (HSP) and immune thrombocytopenia (ITP). However, it is unclear whether a cause-effect relationship exists between them. We aimed to examine the casual effect of IBD on the risk of HSP and ITP. METHODS Based on summary statistics from International IBD Genetics (IIBDG) Consortium and FinnGen study, a two-sample Mendelian randomization study was carried out to determine whether IBD including ulcerative colitis (UC) and Crohn's disease (CD) is causally related to HSP, ITP or secondary thrombocytopenia. To support the results, a variety of sensitivity analyses were performed. RESULTS Significant causal relationships between IBD and HSP (odds ratios = 1.20, 95% confidence interval: 1.07-1.36, adjusted P = 0.006) and ITP (odds ratios =1.22, 95% confidence interval: 1.08-1.38, adjusted P = 0.006) were found. Both genetically predicted UC and CD were positively related with ITP, while CD alone may be responsible for the higher risk of HSP. Besides, no significant association was observed between IBD and secondary thrombocytopenia. CONCLUSIONS The results of this Mendelian randomization study supported the causal association of IBD with HSP and ITP. Taken together, our findings may present implications for management of IBD.
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Affiliation(s)
- Haojia Li
- Inflammatory Bowel Diseases Research Center, Department of Gastroenterology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Qing Xin
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Liping Hong
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Yuqi Hu
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Liangcai Lin
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Mingkai Guo
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Huixin Jiang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Chengcheng He
- Inflammatory Bowel Diseases Research Center, Department of Gastroenterology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shanping Wang
- Inflammatory Bowel Diseases Research Center, Department of Gastroenterology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Mingsong Li
- Inflammatory Bowel Diseases Research Center, Department of Gastroenterology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Kashiwagi H, Kuwana M, Murata M, Shimada N, Takafuta T, Yamanouchi J, Kato H, Hato T, Tomiyama Y. Reference guide for the diagnosis of adult primary immune thrombocytopenia, 2023 edition. Int J Hematol 2024; 119:1-13. [PMID: 37957517 PMCID: PMC10770234 DOI: 10.1007/s12185-023-03672-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 11/15/2023]
Abstract
Primary immune thrombocytopenia (ITP) is an autoimmune disorder characterized by isolated thrombocytopenia due to accelerated platelet destruction and impaired platelet production. Diagnosis of ITP is still challenging because ITP has been diagnosed by exclusion. Exclusion of thrombocytopenia due to bone marrow failure is especially important in Japan because of high prevalence of aplastic anemia compared to Western countries. Hence, we propose a new diagnostic criteria involving the measurement of plasma thrombopoietin (TPO) levels and percentage of immature platelet fraction (RP% or IPF%); 1) isolated thrombocytopenia with no morphological evidence of dysplasia in any blood cell type in a blood smear, 2) normal or slightly increased plasma TPO level (< cutoff), 3) elevated RP% or IPF% (> upper limit of normal), and 4) absence of other conditions that potentially cause thrombocytopenia including secondary ITP. A diagnosis of ITP is made if conditions 1-4 are all met. Cases in which criterion 2 or 3 is not met or unavailable are defined as "possible ITP," and diagnosis of ITP can be made mainly by typical clinical course. These new criteria enable us to clearly differentiate ITP from aplastic anemia and other forms of hypoplastic thrombocytopenia and can be highly useful in clinical practice for avoiding unnecessary bone marrow examination as well as for appropriate selection of treatments.
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Affiliation(s)
- Hirokazu Kashiwagi
- Department of Blood Transfusion, Osaka University Hospital, Suita, Osaka, 565-0871, 2-15, Yamadaoka, Japan.
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Mitsuru Murata
- Center for Clinical Medical Research, International University of Health and Welfare, Ohtawara, Tochigi, Japan
| | - Naoki Shimada
- Center for Basic Medical Research, International University of Health and Welfare, Ohtawara, Tochigi, Japan
| | - Toshiro Takafuta
- Department of Internal Medicine, Hiroshima City Funairi Citizens Hospital, Hiroshima, Hiroshima, Japan
| | - Jun Yamanouchi
- Division of Blood Transfusion and Cell Therapy, Ehime University Hospital, Toon, Ehime, Japan
| | - Hisashi Kato
- Department of Hematology and Oncology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takaaki Hato
- Japanese Red Cross Ehime Blood Center, Matsuyama, Ehime, Japan
| | - Yoshiaki Tomiyama
- Department of Hematology and Oncology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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Hashemzaei M, Ghoshoon MB, Jamshidi M, Moradbeygi F, Hashemzehi A. A Review on Romiplostim Mechanism of Action and the Expressive Approach in E. coli. Recent Pat Biotechnol 2024; 18:95-109. [PMID: 38282441 DOI: 10.2174/1872208317666230503094451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/10/2023] [Accepted: 02/24/2023] [Indexed: 01/30/2024]
Abstract
Immune thrombocytopenic purpura (ITP) is an autoimmune disorder determined by immune-mediated platelet demolition and reduction of platelet production. Romiplostim is a new thrombopoiesis motivating peptibody that binds and stimulates the human thrombopoietin receptor the patent of which was registered in 2008. It is used to treat thrombocytopenia in patients with chronic immune thrombocytopenic purpura. Romiplostim is a 60 kDa peptibody designed to inhibit cross-reacting immune responses. It consists of four high-affinity TPO-receptor binding domains for the Mpl receptor and one human IgG1 Fc domain. Escherichia coli is a good host for the fabrication of recombinant proteins such as romiplostim. The expression of a gene intended in E. coli is dependent on many factors such as a protein's inherent ability to fold, mRNA's secondary structure, its solubility, its toxicity preferential codon use, and its need for post-translational modification (PTM). This review focuses on the structure, function, mechanism of action, and expressive approach to romiplostim in E. coli.
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Affiliation(s)
- Masoud Hashemzaei
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mehrnaz Jamshidi
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Moradbeygi
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Hashemzehi
- Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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20
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Nakayama K, Tamimoto Y, Nakayama T. Successful treatment with belimumab for immune thrombocytopenia associated with systemic lupus erythematosus: A report of two cases. Mod Rheumatol Case Rep 2023; 8:69-73. [PMID: 37718578 DOI: 10.1093/mrcr/rxad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/18/2023] [Accepted: 09/12/2023] [Indexed: 09/19/2023]
Abstract
Immune thrombocytopenia (ITP) is a common complication of systemic lupus erythematosus (SLE). Glucocorticoids (GCs) and hydroxychloroquine are first-line therapy for SLE-associated ITP (SLE-ITP). SLE-ITP in most of patients is less severe and well controlled with GCs, but some of the patients are GC resistant and require additional immunosuppressants including calcineurin inhibitors, azathioprine, and rituximab. We present two cases of SLE-ITP patients treated with belimumab who were resistant to GCs and achieved remission. For severe SLE-ITP, belimumab has emerged as a novel induction therapeutic option.
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MESH Headings
- Humans
- Purpura, Thrombocytopenic, Idiopathic/complications
- Purpura, Thrombocytopenic, Idiopathic/diagnosis
- Purpura, Thrombocytopenic, Idiopathic/drug therapy
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/drug therapy
- Immunosuppressive Agents
- Antibodies, Monoclonal, Humanized
- Glucocorticoids/therapeutic use
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Affiliation(s)
- Kyohei Nakayama
- Department of Rheumatology, Japanese Red Cross Yamaguchi Hospital, Yamaguchi, Japan
| | - Yasuhiro Tamimoto
- Department of Rheumatology, Munakata Medical Association Hospital, Fukuoka, Japan
| | - Tsuyoshi Nakayama
- Department of Rheumatology, Japanese Red Cross Yamaguchi Hospital, Yamaguchi, Japan
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21
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Hassan T, Zakaria M, Diaa A, Abdalla AELS, Ahmed ALSMS, Abdelmonem DM, Abdelaziz E. Contribution of T helper 17 cells and interleukin-17 to the pathogenesis of primary immune thrombocytopenia in Egyptian children. Eur J Pediatr 2023; 182:5673-5679. [PMID: 37823926 PMCID: PMC10746750 DOI: 10.1007/s00431-023-05242-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
Though pathogenesis of primary immune thrombocytopenia (ITP) is still rendered unclear, yet there are many research efforts that have been directed to the role of T helper 17 (Th17) and interleukin 17 (IL-17) in the pathogenesis of this disease. The Th17 cell, which produces IL-17, is a subset of T helper cells. Interleukin 17 is pro-inflammatory cytokine that is recently proved to have a crucial role in the emergence of autoimmune diseases. We aimed to investigate the role of T helper17 cells and interleukin-17 in the pathogenesis of ITP in Egyptian children. This study was carried out on 100 children with ITP and 100 apparently healthy children as a control group. Patients were subjected to full medical history taking, thorough physical examination and routine investigations according to our local standards. Percentage of Th17 cells was measured by flow cytometry in study groups. Also, serum IL-17 was measured in in study groups by ELISA. Th 17 cells were significantly higher in patients compared to controls. Moreover, 3.1-fold increased serum levels of IL-17 were observed in patients with ITP compared to controls. Newly diagnosed patients had significantly higher percentage of Th-17cells as well as higher IL-17 levels than patients with either persistent or chronic ITP. Conclusion: We concluded that Th 17 cells and IL-17 seem to play an important role in the pathogenesis of ITP in Egyptian children. What is Known -- What is New: • The pathogenesis of ITP is heterogeneous A novel subset of CD4+ T cells, distinct from Th1 and Th2, was recently identified. It is characterized by the production of IL-17 and, therefore, designated as Th17 cells. Several studies support a pivotal role for serum cytokines in the pathogenesis of ITP and provide evidence to suggest that helper Tlymphocytes polarize into Th1 and Th2 immune response. we aimed to investigate the role of T helper17 cells and interleukin-17 in the pathogenesis of ITP in Egyptian children.
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Affiliation(s)
- Tamer Hassan
- Pediatrics, Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Marwa Zakaria
- Pediatrics, Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt.
| | - Asmaa Diaa
- Pediatrics, Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | | | | | - Doaa M Abdelmonem
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Eman Abdelaziz
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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22
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Lucchesi A, Lovrencic B, McDonald V, Newland A, Morgan M, Eriksson D, Wilson K, Giordano G, Carli G, Geldman E, Daykin-Pont O, Prince S, Napolitano M. Treatment preferences towards thrombopoietin-receptor agonists for immune thrombocytopenia and experience of disease (TRAPeze): Italy cohort. Hematology 2023; 28:2253069. [PMID: 37680028 DOI: 10.1080/16078454.2023.2253069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE Identify patient preference towards thrombopoietin-receptor agonists (TPO-RAs) and determine the clinical and social impact of immune thrombocytopenia (ITP) in Italy. METHODS The Thrombopoietin-Receptor Agonist Patient experience (TRAPeze) survey collected responses from Italian residents from 17th January to 28th February 2022. TRAPeze utilized a discrete choice experiment (DCE) to elicit patient preferences towards TPO-RA attributes and a patient burden survey (PBS) to determine ITP disease characteristics and social impact. RESULTS Seventy-six respondents completed the DCE, of which 69 completed both the DCE and PBS (mean [range] age 45 [18.0-73.0] years, 80% female). TPO-RA attributes with the greatest influence over respondent choice were method of administration (odds ratio [OR] 2.96; 95% confidence interval [CI] 2.16-4.06), drug-food interactions (OR 1.48; 95% CI 1.17-1.86) and frequency of dosing (OR 1.32; 95% CI 1.15-1.52). Respondents were more likely to prefer therapies administered orally over subcutaneous injection (OR 3.76; 95% CI 2.51-5.63), once weekly over once daily (OR 1.83; 95% CI 1.26-2.65), and therapies without food restrictions over with restrictions (OR 1.58; 95% CI 1.17-2.14).The most frequently reported symptoms were bruising (82%), petechiae (65%) and fatigue (64%). Most respondents (84%) felt ITP impacted familial relationships and 71% of employed respondents reported fatigue influencing their ability to work, with 31% reducing working hours. CONCLUSION Although responses indicated a moderate perception of general health, ITP clearly impacted respondent work and social life. Our findings demonstrate respondents preferred TPO-RAs delivered orally, with less frequent dosing and without food restrictions.
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Affiliation(s)
- Alessandro Lucchesi
- Hematology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Barbara Lovrencic
- Associazione Italiana Porpora Immune Trombocitopenica (AIPIT), Caprino Veronese, Italy
| | - Vickie McDonald
- Department of Clinical Haematology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Adrian Newland
- Academic Haematology Unit, Blizard Institute, Barts & The London School of Medicine & Dentistry, Queen Mary Institute of London, London, UK
| | - Mervyn Morgan
- ITP Support Association, Bolnhurst, Bedfordshire, UK
| | | | - Koo Wilson
- Swedish Orphan Biovitrum AB, Stockholm, Sweden
| | - Giulio Giordano
- Division of Internal Medicine, Hematology Service, Regional Hospital "A. Cardarelli", Campobasso, Italy
| | - Giuseppe Carli
- Department of Hematology, S. Bortolo Hospital, Vicenza, Italy
| | | | | | | | - Mariasanta Napolitano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
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Zhan XY, Chen H, Kong H, Meng T, Ye J, Liu Y, Ng MHL, Li L, Zhang Y, Huang J, Peng Q, Chen C, He Y, Yang M. Platelet dropping, bleeding and new treatment requirements in ITP patients after inactivated COVID-19 vaccination. Immunol Lett 2023; 264:56-63. [PMID: 38006954 DOI: 10.1016/j.imlet.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 11/27/2023]
Abstract
Significant decreases in platelet counts and ITP relapses have been documented in ITP patients receiving COVID-19 mRNA vaccines; however, the effect of the inactivated COVID-19 vaccine on ITP patients remains unclear. The present study aimed to investigate the impact of inactivated COVID-19 vaccines on ITP patients, with a focus on platelet dropping events, bleeding events/scores, and the requirement of a new round of treatment. A total of 118 ITP patients, with 97 chronic ITP and 21 persistent ITP, who received inactivated COVID-19 immunization were investigated retrospectively. Following vaccination (within 1 month), ITP patients reported platelet dropping (31.36 %), new bleeding events (22.88 %), increases in bleeding scores (23.73 %), and new treatment requirements (22.03 %). Among them, persistent ITP patients with disease duration of 3-12 months had higher ratios of the above adverse events (71.43 %, 57.14 %, 61.90 % and 71.43 %, respectively) than chronic ITP patients with duration > 1 year (22.68 %, 15.46 %, 15.46 % and 11.34 %, respectively); patients' disease duration was negatively correlated with platelet dropping events and new treatment requirements. Furthermore, logistic regression analysis also supported the above findings, revealing that persistent ITP patients had 9.40-9.70, 7.24-10.08, and 27.17-28.51 times incidence of having platelet dropping events, new bleeding events, and new treatment requirements after vaccination, respectively, when compared to chronic ITP patients. In conclusion, the present study demonstrates that after receiving inactivated COVID-19 vaccines, ITP patients may experience platelet dropping, which may lead to new bleeding events and the requirement of a new round of treatment for ITP recurrence. As a result, platelet level monitoring is crucial for ITP patients during the vaccination, especially those with persistent ITP.
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Affiliation(s)
- Xiao-Yong Zhan
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Hui Chen
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
| | - Huimin Kong
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | | | - Jieyu Ye
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yong Liu
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Margaret H L Ng
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Liang Li
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yuming Zhang
- Department of Hematology, Hematology Research Institute, Affiliated Hospital of Guangdong Medical University (GDMU), Zhanjiang, China
| | - Jinqi Huang
- Department of Hematology, Hematology Research Institute, Affiliated Hospital of Guangdong Medical University (GDMU), Zhanjiang, China
| | - Qiang Peng
- The Third Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Chun Chen
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
| | - Yulong He
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
| | - Mo Yang
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China; Department of Hematology, Hematology Research Institute, Affiliated Hospital of Guangdong Medical University (GDMU), Zhanjiang, China.
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24
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Gerard Jansen AJ, McDonald V, Newland A, Morgan M, Bastiaanse M, Wilson K, Eriksson D, Geldman E, Daykin-Pont O, Prince S, Zwaginga JJ. Patient preferences and experiences regarding thrombopoietin-receptor agonists for immune thrombocytopenia in The Netherlands (TRAPeze Netherlands study). Hematology 2023; 28:2267942. [PMID: 37818773 DOI: 10.1080/16078454.2023.2267942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE Identify patient experience and preference towards thrombopoietin-receptor agonists (TPO-RAs) in treatment of immune thrombocytopenia (ITP) in the Netherlands. METHODS The Thrombopoietin-Receptor Agonist Patient experience (TRAPeze) survey used a discrete choice experiment (DCE) to elicit patient preferences and a patient burden survey (PBS) to evaluate the clinical and social impact of ITP. TRAPeze collected responses from 6th October to 19th November 2021. RESULTS Seventy-six respondents completed the DCE: treatment preference appeared to be driven by method of administration (odds ratio [OR] 4.33; 95% confidence interval [CI] 2.88-6.52), frequency of dosing (OR 2.33; 95% CI 1.86-2.92) and drug-food interactions (OR 1.91; 95% CI 1.54-2.37). Respondents preferred therapies delivered orally over subcutaneous injection (OR 4.22; 95% CI 2.76-6.46), dosed once weekly over once daily (OR 2.37; 95% CI 1.58-3.54) and without food restrictions over with restrictions (OR 1.90; 95% CI 1.52-2.38). Sixty-nine respondents completed the DCE and PBS (mean [range] age 53 [19-83] years, 65% female). Seven incomplete PBS responses were excluded from analysis. Respondents were currently, or most recently, receiving eltrombopag (n = 43) or romiplostim (n = 26), of which 30% (n = 21/69) had previously received another TPO-RA. Loss (29%, n = 6/21) and lack (29%, n = 6/21) of response were the most common reasons for switching TPO-RA. Only 28% (n = 18/65) of respondents felt their TPO-RA increased energy levels. CONCLUSION Patients preferred therapies delivered orally, dosed less frequently and without food restrictions. QoL of ITP patients on TPO-RAs can be improved; the burden analyses presented can inform future efforts towards this.
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Affiliation(s)
- A J Gerard Jansen
- Department of Haematology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Vickie McDonald
- Department of Clinical Haematology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Adrian Newland
- Academic Haematology Unit, Blizzard Institute, Barts & The London School of Medicine & Dentistry, Queen Mary Institute of London, London, UK
| | | | | | | | | | | | | | | | - Jaap Jan Zwaginga
- Department of Haematology, Leiden University Medical Centre, Leiden, Netherlands
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25
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Kubrusly BS, Kubrusly ES, Rocha HAL, Júnior ABV, Kubrusly MS, Ribeiro LLPA, Ribeiro RDA, Duarte FB. Epidemiology of immune thrombocytopenia: study of adult patients at a referral hematology service in Northeastern Brazil. Hematol Transfus Cell Ther 2023:S2531-1379(23)02585-3. [PMID: 38177057 DOI: 10.1016/j.htct.2023.09.2363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/04/2023] [Accepted: 09/05/2023] [Indexed: 01/06/2024] Open
Abstract
Immune thrombocytopenia (ITP) is an acquired bleeding disorder observed in the clinical practice. Little is known about its epidemiology in Brazil. The present study was conducted at a hematology referral center which covers a population of over 8 million in 184 municipalities in the state of Ceará. The purpose of this study was to draw a demographic profile of adult ITP patients with regard to sex, age, geographical origin and distribution across the state, and the proportion of secondary ITP. Following ethics committee approval, information was collected with an ad hoc instrument. The sample consisted of 187 adult ITP patients attending the Walter Cantídio University Hospital in 2015. The median follow-up time was 67 months (range: 1 month to 29 years). Female sex (n = 154; 82.35 %) was strongly prevalent in all age brackets, with an overall female/male ratio of 4.7:1. The median age was 41 ± 16.1 with an interquartile range of 29-55.5 years; there was no difference between the genders. Secondary ITP (18/187; 9.6 %) displayed a bimodal distribution and a linear increase between 38 and >68 years of age. The results of this survey on the epidemiology of ITP in Brazil suggest that ethnic and geographical factors may have a great impact on age and sex distribution and on the distribution of secondary ITP.
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Affiliation(s)
| | - Elsie Sobreira Kubrusly
- Hospital Universitário Walter Cantídio of the Universidade Federal do Ceará, (HUWC-UFC), Fortaleza, CE, Brazil; Medicine School of the Centro Universitário Christus (UNICHRISTUS), Fortaleza, CE, Brazil
| | - Hermano Alexandre Lima Rocha
- Medicine School of the Universidade Federal do Ceará (FAMED-UFC), Fortaleza, CE, Brazil; Medicine School of the Centro Universitário Christus (UNICHRISTUS), Fortaleza, CE, Brazil
| | - Antonio Brazil Viana Júnior
- Hospital Universitário Walter Cantídio of the Universidade Federal do Ceará, (HUWC-UFC), Fortaleza, CE, Brazil; Maternidade-Escola Assis Chateaubriand, Universidade Federal do Ceará (MEAC UFC), Fortaleza, CE, Brazil
| | | | | | | | - Fernando Barroso Duarte
- Medicine School of the Universidade Federal do Ceará (FAMED-UFC), Fortaleza, CE, Brazil; Hospital Universitário Walter Cantídio of the Universidade Federal do Ceará, (HUWC-UFC), Fortaleza, CE, Brazil; Medicine School of the Centro Universitário Christus (UNICHRISTUS), Fortaleza, CE, Brazil
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26
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Takehara T, Nishida H, Ichikawa K, Hosokawa Y, Nawano T, Takai S, Fukuhara H, Himuro M, Tsuchiya N, Watanabe M. Immune thrombocytopenia secondary to primary cytomegalovirus infection after renal transplantation treated with a thrombopoietin receptor agonist: a case report. BMC Nephrol 2023; 24:336. [PMID: 37957545 PMCID: PMC10644401 DOI: 10.1186/s12882-023-03385-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Immune thrombocytopenia (ITP) is an acquired disorder characterised by a low platelet count due to immune-mediated destruction and impaired platelet production. Here we report a rare case of primary cytomegalovirus (CMV) infection followed by thrombocytopenia after renal transplantation (RT). CASE PRESENTATION A 24-year-old male patient with end-stage kidney disease secondary to hereditary focal segmental glomerulosclerosis was treated with peritoneal dialysis and received ABO-compatible living-related RT from his aunt. Nine months after the RT, the patient was diagnosed with primary CMV infection. After initiating treatment for primary CMV infection, the patient developed thrombocytopenia. After excluding other diseases or drugs that may cause thrombocytopenia, the patient was finally diagnosed with ITP, administered prednisolone (PSL), and started on Helicobacter pylori eradication therapy. Tapering the PSL dose was difficult, but thrombopoietin receptor agonists (TPO-RAs) were effective. CONCLUSIONS In this case, the patient was diagnosed with ITP, and other causes of thrombocytopenia after RT were successfully ruled out. This case report demonstrates that RT recipients can develop ITP after CMV infection, and, in such cases, TPO-RAs may be an attractive option as a second-line therapy.
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Affiliation(s)
- Tomohiro Takehara
- Department of Cardiology, Pulmonology, and Nephrology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
| | - Hayato Nishida
- Department of Urology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Kazunobu Ichikawa
- Department of Cardiology, Pulmonology, and Nephrology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Yuka Hosokawa
- Department of Internal Medicine III, Division of Hematology and Cell Therapy, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Takaaki Nawano
- Department of Cardiology, Pulmonology, and Nephrology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Satoshi Takai
- Department of Urology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Hiroki Fukuhara
- Department of Urology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Masahito Himuro
- Department of Internal Medicine III, Division of Hematology and Cell Therapy, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Norihiko Tsuchiya
- Department of Urology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
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27
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Han S, Lu H, Yu Y, Liu X, Jing F, Wang L, Zhao Y, Hou M. Hyperlipidemia in immune thrombocytopenia: a retrospective study. Thromb J 2023; 21:102. [PMID: 37784127 PMCID: PMC10544441 DOI: 10.1186/s12959-023-00545-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/13/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Immune thrombocytopenia (ITP) is an autoimmune hemorrhagic disease characterized by low platelet count and bleeding manifestations. However, some patients also suffered from atherosclerosis or even infarction. Apart from activated platelets, lipid metabolism takes a large part in the formation of atherosclerosis and metabolic syndrome. The lipid metabolic state in ITP patients is still unknown. METHODS We retrospectively reviewed 302 hospitalized ITP patients in our cohort, comparing their blood lipids, bleeding symptoms, metabolic diseases and treatment responses. RESULTS We found a high proportion of ITP patients suffered from hyperlipidemia, and other metabolic diseases including cardiovascular or cerebral atherosclerosis or infarction, hypertension, and type 2 diabetes. Hyperlipidemia was associated with severe bleeding and treatment refractoriness in ITP. Statins could alleviate thrombocytopenia and bleeding severity, and facilitate ITP treatment, while improving hyperlipidemia in ITP patients. CONCLUSIONS Our present study demonstrated that lipid metabolism might play an indispensable role in ITP pathogenesis and development.
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Affiliation(s)
- Shouqing Han
- Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China
- Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital of Shandong University, Jinan, China
| | - Hui Lu
- Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Yafei Yu
- Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China
- Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital of Shandong University, Jinan, China
| | - Xinguang Liu
- Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China
- Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital of Shandong University, Jinan, China
| | - Fangmiao Jing
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Liang Wang
- Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China.
- Department of Hematology, Shengli Oilfield Central Hospital, Dongying, China.
| | - Yajing Zhao
- Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China.
- Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital of Shandong University, Jinan, China.
| | - Ming Hou
- Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China.
- Leading Research Group of Scientific Innovation, Department of Science and Technology of Shandong Province, Qilu Hospital of Shandong University, Jinan, China.
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An ZY, Wu YJ, Hou Y, Mei H, Nong WX, Li WQ, Zhou H, Feng R, Shen JP, Peng J, Zhou H, Liu Y, Song YP, Yang LH, Fang MY, Li JY, Cheng YF, Liu P, Xu YJ, Wang Z, Luo Y, Cai Z, Liu H, Wang JW, Li J, Zhang X, Sun ZM, Zhu XY, Wang X, Fu R, Huang L, Wang SY, Yang TH, Su LP, Ma LM, Chen XQ, Liu DH, Yao HX, Feng J, Zhang HY, Jiang M, Zhou ZP, Wang WS, Shen XL, Baima Y, Li YY, Wang QF, Huang QS, Fu HX, Zhu XL, He Y, Jiang Q, Jiang H, Lu J, Zhao XY, Chang YJ, Wu T, Pan YZ, Qiu L, Gao D, Jin AR, Li W, Gao SJ, Zhang L, Hou M, Huang XJ, Zhang XH. A life-threatening bleeding prediction model for immune thrombocytopenia based on personalized machine learning: a nationwide prospective cohort study. Sci Bull (Beijing) 2023; 68:2106-2114. [PMID: 37599175 DOI: 10.1016/j.scib.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/24/2023] [Accepted: 06/26/2023] [Indexed: 08/22/2023]
Abstract
Rare but critical bleeding events in primary immune thrombocytopenia (ITP) present life-threatening complications in patients with ITP, which severely affect their prognosis, quality of life, and treatment decisions. Although several studies have investigated the risk factors related to critical bleeding in ITP, large sample size data, consistent definitions, large-scale multicenter findings, and prediction models for critical bleeding events in patients with ITP are unavailable. For the first time, in this study, we applied the newly proposed critical ITP bleeding criteria by the International Society on Thrombosis and Hemostasis for large sample size data and developed the first machine learning (ML)-based online application for predict critical ITP bleeding. In this research, we developed and externally tested an ML-based model for determining the risk of critical bleeding events in patients with ITP using large multicenter data across China. Retrospective data from 8 medical centers across the country were obtained for model development and prospectively tested in 39 medical centers across the country over a year. This system exhibited good predictive capabilities for training, validation, and test datasets. This convenient web-based tool based on a novel algorithm can rapidly identify the bleeding risk profile of patients with ITP and facilitate clinical decision-making and reduce the occurrence of adversities.
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Affiliation(s)
- Zhuo-Yu An
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China; Collaborative Innovation Center of Hematology, Peking University, Beijing 100044, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China; National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - Ye-Jun Wu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China; Collaborative Innovation Center of Hematology, Peking University, Beijing 100044, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China; National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - Yu Hou
- Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250014, China
| | - Heng Mei
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Wei-Xia Nong
- Department of Hematology, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi 832002, China
| | - Wen-Qian Li
- Department of Hematology, Qinghai Provincial People's Hospital, Xining 810007, China
| | - Hu Zhou
- Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Henan Institute of Hematology, Zhengzhou 450008, China
| | - Ru Feng
- Department of Hematology, Beijing Hospital, Beijing 100044, China
| | - Jian-Ping Shen
- Department of Hematology, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou 310006, China
| | - Jun Peng
- Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250014, China
| | - Hai Zhou
- Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250014, China
| | - Yi Liu
- Department of Hematology, Senior Department of Hematology, the Fifth Medical Center of PLA General Hospital, Beijing 100044, China
| | - Yong-Ping Song
- Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Henan Institute of Hematology, Zhengzhou 450008, China
| | - Lin-Hua Yang
- Department of Hematology, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Mei-Yun Fang
- Department of Hematology, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Jian-Yong Li
- Department of Hematology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Nanjing 210029, China
| | - Yun-Feng Cheng
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Peng Liu
- Department of Hematology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Ya-Jing Xu
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing 100044, China
| | - Zhao Wang
- Institute of Hematology, the First Affiliated Hospital, Zhejiang University, Hangzhou 310058, China
| | - Yi Luo
- Department of Hematology, Beijing Tongren Hospital, Beijing 100005, China
| | - Zhen Cai
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Hui Liu
- Department of Hematology, Beijing Hospital, Beijing 100044, China
| | - Jing-Wen Wang
- Department of Hematology, Beijing Tongren Hospital, Beijing 100005, China
| | - Juan Li
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Xi Zhang
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing 400037, China
| | - Zi-Min Sun
- Department of Hematology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Xiao-Yu Zhu
- Department of Hematology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Xin Wang
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250014, China
| | - Rong Fu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Liang Huang
- Institute of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Shao-Yuan Wang
- Department of Hematology, Fujian Institute of Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Tong-Hua Yang
- Department of Hematology, the First People's Hospital of Yunnan Province, Kunming 650032, China
| | - Li-Ping Su
- Department of Hematology, Shanxi Tumor Hospital Affiliated to Shanxi Medical University, Taiyuan 030001, China
| | - Liang-Ming Ma
- Department of Hematology, Shanxi Bethune Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Xie-Qun Chen
- Department of Hematology, The Affiliated Hospital of Northwest Hospital, Xi'an No.3 Hospital, Xi'an 710054, China
| | - Dai-Hong Liu
- Department of Hematology, Chinese PLA General Hospital & PLA Medical School, Beijing 100044, China
| | - Hong-Xia Yao
- Department of Hematology, Hainan Affiliated Hospital of Hainan Medical University, Hainan General Hospital, Haikou 570311, China
| | - Jia Feng
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Hong-Yu Zhang
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Ming Jiang
- Center of Hematologic Diseases, The First Affiliated Hospital of Xinjiang Medical University, Urumchi 830054, China
| | - Ze-Ping Zhou
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650500, China
| | - Wen-Sheng Wang
- Department of Hematology, Peking University First Hospital, Beijing 100034, China
| | - Xu-Liang Shen
- Department of Hematology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, China
| | - Yangjin Baima
- Department of Hematology, People's Hospital of Tibet Autonomous Region, Lhasa 850000, China
| | - Yue-Ying Li
- Key Laboratory of Genomic and Precision Medicine, Collaborative Innovation Center of Genetics and Development, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing 100029, China
| | - Qian-Fei Wang
- Key Laboratory of Genomic and Precision Medicine, Collaborative Innovation Center of Genetics and Development, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing 100029, China
| | - Qiu-Sha Huang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China; Collaborative Innovation Center of Hematology, Peking University, Beijing 100044, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China; National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - Hai-Xia Fu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China; Collaborative Innovation Center of Hematology, Peking University, Beijing 100044, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China; National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - Xiao-Lu Zhu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China; Collaborative Innovation Center of Hematology, Peking University, Beijing 100044, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China; National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - Yun He
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China; Collaborative Innovation Center of Hematology, Peking University, Beijing 100044, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China; National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - Qian Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China; Collaborative Innovation Center of Hematology, Peking University, Beijing 100044, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China; National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - Hao Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China; Collaborative Innovation Center of Hematology, Peking University, Beijing 100044, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China; National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - Jin Lu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China; Collaborative Innovation Center of Hematology, Peking University, Beijing 100044, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China; National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - Xiang-Yu Zhao
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China; Collaborative Innovation Center of Hematology, Peking University, Beijing 100044, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China; National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - Ying-Jun Chang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China; Collaborative Innovation Center of Hematology, Peking University, Beijing 100044, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China; National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - Tao Wu
- Department of Hematology, The 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou 730050, China
| | - Yao-Zhu Pan
- Department of Hematology, The 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou 730050, China
| | - Lin Qiu
- Institute of Hematology, Harbin the First Hospital, Harbin 150001, China
| | - Da Gao
- Department of Hematology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - A-Rong Jin
- Department of Hematology, Inner Mongolia People's Hospital, Hohhot 010017, China
| | - Wei Li
- Department of Hematology, The First Bethune Hospital of Jilin University, Changchun 130021, China
| | - Su-Jun Gao
- Department of Hematology, The First Bethune Hospital of Jilin University, Changchun 130021, China
| | - Lei Zhang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China.
| | - Ming Hou
- Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250014, China.
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China; Collaborative Innovation Center of Hematology, Peking University, Beijing 100044, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China; National Clinical Research Center for Hematologic Disease, Beijing 100044, China.
| | - Xiao-Hui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China; Collaborative Innovation Center of Hematology, Peking University, Beijing 100044, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China; National Clinical Research Center for Hematologic Disease, Beijing 100044, China.
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CAI J, YANG G, ZHANG X, LIU L, YAN M. [ Immune Thrombocytopenia Induced by Sintilimab in Lung Cancer:
A Case Report and Literature Review]. Zhongguo Fei Ai Za Zhi 2023; 26:717-720. [PMID: 37985158 PMCID: PMC10600748 DOI: 10.3779/j.issn.1009-3419.2023.102.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Indexed: 11/22/2023]
Abstract
Immune checkpoint inhibitors (ICIs) show unique advantages in the treatment of lung cancer, making the treatment of lung cancer enter the era of immunotherapy, but ICIs will also have adverse reactions, and the incidence of immune-induced hematological toxicity is not very high. Immunotherapy-induced thrombocytopenia is a rare adverse event.We report one case of thrombocytopenia induced by ICIs and review the literature on thrombocytopenia associated with ICIs and discuss the clinical features, possible mechanisms, and optimal treatment.
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徐 龙, 曹 峰, 仝 瑞, 王 臣, 张 迎. [Relationship between coronavirus disease 2019 vaccination and the risk of immune thrombocytopenia]. Zhongguo Dang Dai Er Ke Za Zhi 2023; 25:966-970. [PMID: 37718404 PMCID: PMC10511229 DOI: 10.7499/j.issn.1008-8830.2302074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/08/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES To study the relationship between coronavirus disease 2019 (COVID-19) vaccination and the risk of immune thrombocytopenia (ITP). METHODS A retrospective analysis was conducted on children aged 3-17 years with newly diagnosed ITP who were hospitalized in Children's Hospital Affiliated to Zhengzhou University from November 2021 to December 2022. Clinical data and COVID-19 vaccination status were compared among three groups: ITP patients vaccinated within 12 weeks before onset, vaccinated more than 12 weeks before onset, and unvaccinated. Changes in serum immunoglobulin and complement levels were analyzed among five groups: ITP patients vaccinated <4 weeks before onset, 4-<8 weeks before onset, 8-<12 weeks before onset, ≥12 weeks before onset, and unvaccinated. A case-control design was used to estimate the risk of ITP: 387 children aged 3-17 years with fractures hospitalized during the same period in the emergency department of the hospital were selected as the control group, and the exposure to COVID-19 vaccination within 12, 8, and 4 weeks before onset in ITP children was compared to estimate the risk of ITP. RESULTS Among 129 ITP children, there were no statistically significant differences in age, gender, rate of preceding infections, absolute platelet count at initial diagnosis, absolute lymphocyte count at initial diagnosis, bleeding score, positive anti-nuclear antibody rate, absolute platelet count after 4 days of treatment, recurrence rate, and proportion of patients with disease duration ≥3 months among the three groups vaccinated within 12 weeks before onset, vaccinated more than 12 weeks before onset, and unvaccinated (P>0.05). There was a statistically significant difference in serum immunoglobulin G, immunoglobulin A, and complement component 3 levels among the groups vaccinated <4 weeks, 4-<8 weeks, 8-<12 weeks, and ≥12 weeks before onset, and unvaccinated (P<0.05). The risk estimation results showed that COVID-19 vaccination within 12 weeks, 8 weeks, and 4 weeks before onset did not increase the risk of ITP (P>0.05). CONCLUSIONS COVID-19 vaccination does not increase the risk of ITP.
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Beyene DA, Sisay EA, Fentie AM, Gebremedhin A. Reliability and validity of the Amharic version of immune thrombocytopenia life quality index tool for assessment of the health-related quality of life in Ethiopian patients of immune thrombocytopenia: Cross-sectional study. SAGE Open Med 2023; 11:20503121231199869. [PMID: 37719164 PMCID: PMC10504833 DOI: 10.1177/20503121231199869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023] Open
Abstract
Background Platelet count and bleeding risk are frequently used in clinical assessments of the severity of immune thrombocytopenia. On the other hand, immune thrombocytopenia also influences patients' health-related quality of life. The immune thrombocytopenia life quality index is a new tool for evaluating health-related quality of life in immune thrombocytopenia patients. Objective To assess the psychometric properties of the Amharic version of the immune thrombocytopenia life quality index tool for immune thrombocytopenia patients in Ethiopia. Methods The facility-based cross-sectional study was carried out from 15 September to 30 October 2022. The school of pharmacy institutional ethics review board provided ethical clearance and approval of the study protocol (approval number: ERB/SOP/487/14/2022). Both written informed consent and family or legal guardian consent were obtained for participants aged 14-18 years and informed consent for participants aged >18 years. The tool was forward-backward translated before being pretested on five immune thrombocytopenia patients. Descriptive statistics were used to report sociodemographic and clinical data. The psychometric properties of the immune thrombocytopenia life quality index in Amharic were evaluated for acceptability, reliability, and construct validity. Results This study included 100 participants, at the age of diagnosis of immune thrombocytopenia, the median with inter-quartile range of platelet count (×109/L) was 15.00 (18.00). The majority of study participants (79, 79%) received prednisolone alone as first-line therapy. The tool psychometric test was reliable; the correlation coefficient between items ranged from 0.147 to 0.956, and the overall Cronbach's alpha coefficient was 0.956. Furthermore, the tool was construct-valid, with factor analysis between components revealing that Item-1 had an eigenvalue greater than one and explained 72.532% of the total variance among all 10 immune thrombocytopenia life quality index domains. The immune thrombocytopenia life quality index total (alternative score) had a strong (r = 0.9) correlation with Item-8 and a moderate (r = 0.317) correlation with Item-5. Conclusion The Amharic version of the immune thrombocytopenia life quality index tool is a valid and reliable tool that can be used to assess the health-related quality of life of immune thrombocytopenia patients in Ethiopia.
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Affiliation(s)
- Dessale Abate Beyene
- Department of Pharmacology and Clinical Pharmacy, Tikur Anbessa Specialized Hospital, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eskinder Ayalew Sisay
- Department of Pharmacology and Clinical Pharmacy, Tikur Anbessa Specialized Hospital, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalay Mulu Fentie
- Department of Pharmacology and Clinical Pharmacy, Tikur Anbessa Specialized Hospital, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amha Gebremedhin
- Tikur Anbessa Specialized Hospital, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Goyal VD, Pahade A, Misra G, Kaira V. Mitral valve replacement in patients of rheumatic heart disease associated with immune thrombocytopenia. Indian J Thorac Cardiovasc Surg 2023; 39:516-521. [PMID: 37609607 PMCID: PMC10441999 DOI: 10.1007/s12055-023-01517-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/02/2023] [Accepted: 04/05/2023] [Indexed: 08/24/2023] Open
Abstract
Immune thrombocytopenia in association with rheumatic heart disease is not commonly seen. Surgical management of rheumatic heart disease becomes more challenging in the presence of immune thrombocytopenia. The risk of complications increases manifold and judicious medical management before, during, and after surgery is imperative. We discuss two such cases, the complications we faced and the problems we anticipated before, and their prevention. Both patients were managed without using immunoglobulins or doing splenectomy. The literature on valve replacement in patients of immune thrombocytopenia and the implications of immune thrombocytopenia in the management of patients with rheumatic heart disease is also reviewed.
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Affiliation(s)
| | - Akhilesh Pahade
- Department of Anaesthesia, SRMS, IMS, Bareilly, UP 243202 India
| | - Gaurav Misra
- Department of Anaesthesia, SRMS, IMS, Bareilly, UP 243202 India
| | - Vaanika Kaira
- Department of Pathology, SRMS, IMS, Bareilly, UP 243202 India
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Xiang Y, Liu L, Hou Y, Du S, Xu S, Zhou H, Shao L, Li G, Yu T, Liu Q, Xue M, Yang J, Peng J, Hou M, Shi Y. The mTORC1 pathway participate in hyper-function of B cells in immune thrombocytopenia. Ann Hematol 2023; 102:2317-2327. [PMID: 37421506 DOI: 10.1007/s00277-023-05348-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
B cell hyper-function plays an important role in the pathogenesis of immune thrombocytopenia (ITP), but the molecular mechanisms underlying such changes remain unclear. We sought to identify regulators of B cell dysfunction in ITP patients through transcriptome sequencing and the use of inhibitors. B cells were isolated from PBMC of 25 ITP patients for B cell function test and transcriptome sequencing. For the potential regulatory factors identified by transcriptome sequencing, the corresponding protein inhibitors were used to explore the regulatory effect of the regulatory factors on B cell dysfunction in vitro. In this study, increased antibody production, enhanced terminal differentiation and highly expressed costimulatory molecules CD80 and CD86 were found in B cells of patients with ITP. In addition, RNA sequencing revealed highly activated mTOR pathway in these pathogenic B cells, indicating that the mTOR pathway may be involved in B cell hyper-function. Furthermore, mTOR inhibitors rapamycin or Torin1 effectively blocked the activation of mTORC1 in B cells, resulting in reduce antibody secretion, impaired differentiation of B cells into plasmablasts and downregulation of costimulatory molecules. Interestingly, as an unspecific inhibitor of mTORC2 besides mTORC1, Torin1 did not show a stronger capacity to modulate B cell function than rapamycin, suggesting that the regulation of B cells by Torin1 may depend on blockade of mTORC1 rather than mTORC2 pathway. These results indicated that the activation of mTORC1 pathway is involved in B cell dysfunction in patients with ITP, and inhibition of mTORC1 pathway might be a potential therapeutic approach for ITP.
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Affiliation(s)
- Yujiao Xiang
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
| | - Lu Liu
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
- Department of Hematology, Qilu Hospital (Qingdao) of Shandong University, Qingdao, China
| | - Yu Hou
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
- Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital of Shandong University, Jinan, China
- Department of Hematology, Qilu Hospital (Qingdao) of Shandong University, Qingdao, China
| | - Shenghong Du
- Department of Hematology, Taian Central Hospital, Taian, China
| | - Shuqian Xu
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
| | - Hai Zhou
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
| | - Linlin Shao
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
| | - Guosheng Li
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
| | - Tianshu Yu
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
| | - Qiang Liu
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
| | - Meijuan Xue
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
| | - Junhui Yang
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
| | - Jun Peng
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
- Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital of Shandong University, Jinan, China
| | - Ming Hou
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
- Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital of Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center in Hematological Diseases, Jinan, China
- Leading Research Group of Scientific Innovation, Department of Science and Technology of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Yan Shi
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China.
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Frohlich M, Knights K, Springer NL. Determination of optimal storage time and temperature for the detection of red blood cell and platelet surface-associated immunoglobulin by flow cytometry in healthy horses. Vet Immunol Immunopathol 2023; 263:110643. [PMID: 37595493 DOI: 10.1016/j.vetimm.2023.110643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023]
Abstract
Differentiating immune-mediated causes from other causes of anemia and thrombocytopenia can be challenging. Flow cytometry can detect surface-associated immunoglobulin (sIg) on red blood cells (RBC) and platelets (PLT) in dogs and horses. Sample storage parameters for ideal assay performance has not been evaluated in horses. The study objective is to identify optimal storage time and temperature of equine whole blood for the detection of RBC-sIg and PLT-sIg via flow cytometry. Both assays were performed on samples at time 0, 4, 24, 48, and 72 h post collection. RBC-sIg samples were stored at 4 °C and PLT-sIg samples were stored at 4 °C and room temperature. RBC-sIg percentages were stable up to 72 h storage. Platelet surface-associated IgG percent positive platelets increased above baseline at all timepoints and percent positive platelets were inconsistent across timepoints for IgM and IgA. PLT-sIg testing should ideally be performed within 4 h of collection. In instances where this is not feasible, samples should be stored at 4 °C and analyzed no later than 24 h after collection. Whereas cutoff values for RBC-sIg remained similar across timepoints, results for PLT-sIg should be compared to time-specific cutoff or reference intervals established by the laboratory running the test.
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Affiliation(s)
- Miranda Frohlich
- Department of Diagnostic Medicine/Pathobiology, Kansas State University College of Veterinary Medicine, 1800 Denison Ave, Manhattan, KS 66506, USA
| | - Kaori Knights
- Department of Diagnostic Medicine/Pathobiology, Kansas State University College of Veterinary Medicine, 1800 Denison Ave, Manhattan, KS 66506, USA
| | - Nora L Springer
- Department of Diagnostic Medicine/Pathobiology, Kansas State University College of Veterinary Medicine, 1800 Denison Ave, Manhattan, KS 66506, USA.
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Yu J, Miao P, Qian S. Application of recombinant human thrombopoietin in pregnant women with immune thrombocytopenia: a single-center experience of four patients and literature review. J Int Med Res 2023; 51:3000605231187950. [PMID: 37548331 PMCID: PMC10408329 DOI: 10.1177/03000605231187950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/12/2023] [Indexed: 08/08/2023] Open
Abstract
The management of pregnant women with immune thrombocytopenia who fail to respond to corticosteroids and intravenous immunoglobulin is an intractable clinical challenge because of the limited availability of evidence-based information. Recombinant human thrombopoietin (rhTPO) is recommended for refractory immune thrombocytopenia (ITP). To date, however, few studies have investigated rhTPO treatment during pregnancy. We retrospectively reviewed four cases who were diagnosed with ITP and treated with rhTPO during pregnancy in our center from January 2015 to June 2020. Of the four cases, two (50%) responded to rhTPO treatment. No adverse events were noted in the newborns. Our findings indicate that rhTPO treatment is safe for patients with refractory gestational ITP, and that subcutaneous injection is a convenient delivery method that does not lead to adverse events. Thus, rhTPO may be a viable alternative treatment option for patients with refractory gestational ITP who do not respond to first-line therapies.
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Affiliation(s)
- Jingdi Yu
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Peiwen Miao
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shenxian Qian
- Department of Hematology, Affiliated Hangzhou First People’s Hospital, Zhejiang Chinese Medical University, Hangzhou, China
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Chandrakala S, Toshniwal M, Halvawala M, Padwal N, Sidharthan N, Malhotra P, Prashantha B, Ballikar R, Shah S, Apte S, Viswanathan TK, Ramanan V, Sharma A, Pawar D, Pawar R, Shahavi V. Efficacy and Safety of Biosimilar Romiplostim Versus Innovator Romiplostim in Patients with Chronic Immune Thrombocytopenia. Indian J Hematol Blood Transfus 2023; 39:435-441. [PMID: 37304488 PMCID: PMC10247600 DOI: 10.1007/s12288-022-01602-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Romiplostim is a Food and Drug Administration (FDA)-approved therapy for immune thrombocytopenia (ITP). Biosimilar is a biological product that has no clinical meaningful difference from an existing FDA-approved reference product. It has a potential of lowering health-care-related cost. Biosimilar of romiplostim can be made available to patients with ITP at a low cost and can be beneficial in providing the best therapy. Thus, the efficacy and safety of biosimilar romiplostim (ENZ110) was compared with innovator romiplostim (Nplate) with respect to platelet response in patients with chronic ITP. This was a prospective, multicenter, randomized, and double-blind clinical trial. Patients with chronic ITP, aged 18-65 years, were enrolled in a study and were randomized to receive either ENZ110 or Nplate in a 3:1 ratio for a treatment period of 12 weeks, respectively. After completion of the treatment period, the patients were followed-up for one week to evaluate the platelet response and to monitor the adverse events (AEs). Over the duration of 12 weeks, platelet response of > 50 × 109/L was achieved in 85.3% patients treated with ENZ110 and in 75.0% patients treated with Nplate in per protocol population. In intent-to-treat population, 83.8% patients with ENZ110 and 76.9% patients with Nplate achieved a platelet response of > 50 × 109/L. In the ENZ110 group, 111 AEs were recorded in 66.7% patients, while 18 AEs were reported in 61.5% patients in the Nplate group. The study demonstrated non-inferiority with comparable efficacy and safety between biosimilar romiplostim and innovator romiplostim in patients with chronic ITP. Trial registration number and date of registration: CTRI/2019/04/018614.
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Affiliation(s)
- S. Chandrakala
- Seth G. S. Medical College and KEM Hospital, Mumbai, India
| | | | | | | | | | - Pankaj Malhotra
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - B. Prashantha
- Kasturba Medical College (KMC) Hospital, Mangalore, India
| | - Riya Ballikar
- Criticare Hospital and Research Institute, Nagpur, India
| | | | | | | | - Vijay Ramanan
- Grant Medical Foundation Ruby Hall Clinic, Pune, India
| | - Akhilesh Sharma
- Medical Affairs Department, Alkem Laboratories Limited, Alkem House, Senapati Bapat Marg,Lower Parel, Mumbai, India
| | - Dattatray Pawar
- Medical Affairs Department, Alkem Laboratories Limited, Alkem House, Senapati Bapat Marg,Lower Parel, Mumbai, India
| | - Roshan Pawar
- Medical Affairs Department, Alkem Laboratories Limited, Alkem House, Senapati Bapat Marg,Lower Parel, Mumbai, India
| | - Vinayaka Shahavi
- Medical Affairs Department, Alkem Laboratories Limited, Alkem House, Senapati Bapat Marg,Lower Parel, Mumbai, India
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Boleto G, Avouac J, Godeau B, Allanore Y. Severe immune thrombocytopenia in two patients with systemic sclerosis. Joint Bone Spine 2023; 90:105560. [PMID: 36933783 DOI: 10.1016/j.jbspin.2023.105560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/15/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023]
Abstract
Thrombocytopenia in the context of systemic sclerosis (SSc) is rare. It should primarily raise the possibility of scleroderma renal crisis. Immune thrombocytopenia (ITP) is another cause of low platelets that is common in systemic lupus erythematosus, but tremendously rare in patients with SSc. We herein report two cases of severe ITP in patients with SSc. The first case is a 29-year-old woman with very low platelet counts (2×109/L) that did not increase despite receiving corticosteroids, intravenous immunoglobulins (IVig), rituximab and romiplostim. Because of a symptomatic acute subdural haematoma, emergency splenectomy was performed and subsequently platelet counts normalised without neurological sequelae. The second case is a 66-year-old woman in whom self-limited mild epistaxis revealed low platelet counts (8×109/L). The patient did not improve after the use of IVig and corticosteroids. Secondarily rituximab and romiplostim normalised the platelet counts after 8 weeks. To the best of our knowledge this is the first reported case of severe ITP in a patient with diffuse cutaneous SSc and anti-topoisomerase antibodies.
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Affiliation(s)
- Gonçalo Boleto
- Department of Rheumatology, université Paris Cité, Cochin Hospital, Paris, France
| | - Jérôme Avouac
- Department of Rheumatology, université Paris Cité, Cochin Hospital, Paris, France; Inserm U1016, institut Cochin, CNRS UMR8104, Paris, France
| | - 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
| | - Yannick Allanore
- Department of Rheumatology, université Paris Cité, Cochin Hospital, Paris, France; Inserm U1016, institut Cochin, CNRS UMR8104, Paris, France.
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Zhang W, Xie S, Fu R, Chen Y, Liu W, Sun T, Ju M, Li H, Xue F, Zhang L, Liu X, Yang R. Fatigue and health-related quality of life in patients with immune thrombocytopenia: a longitudinal assessment in China. Expert Rev Hematol 2023; 16:1125-1133. [PMID: 38009277 DOI: 10.1080/17474086.2023.2286730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/22/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND There is lacking studies of longitudinally assessment of fatigue and health-related quality of life (HRQoL) among Chinese immune thrombocytopenia (ITP) adults. We aimed to evaluate changes in fatigue and HRQoL and identify the associated factors. METHODS Patients' characteristics, Functional Assessment of Chronic Illness Therapy (FACIT-F) and the ITP-specific Patient Assessment Questionnaire (ITP-PAQ) scores at admission (T0), at discharge (T1), and three months after discharge (T2) were collected. Linear mixed effects models were used to examine changes over time. RESULTS We included 175 patients. The mean score of FACIT-F at T0 was 37.2 and increased at T1 (39.0), while then decreased at T2 (34.7). Patients who were single, retired, had persistent ITP, splenomegaly had more severe fatigue, whereas those who had not received any prior treatment and had a bleeding score of 0 at admission had milder fatigue. The mean score of ITP-PAQ was 57.7 at T0, then gradually increased to 60.3 at T1 and 62.8 at T2. Patients with persistent ITP and those who have never received treatment for ITP have better HRQoL. CONCLUSION ITP adults' fatigue and HRQoL were impaired. Patients' fatigue improved at discharge but worsened at three months after discharge, while HRQoL gradually improved over time.
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Affiliation(s)
- Wenhui Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Shitong Xie
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Rongfeng Fu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yunfei Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Wei Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Ting Sun
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Mankai Ju
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Huiyuan Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Feng Xue
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Lei Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Xiaofan Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Renchi Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
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Nokhostin F, Bakhshpour F, Pezeshki SMS, Khademi R, Saki N. Immune thrombocytopenia: a review on the pathogenetic role of immune cells. Expert Rev Hematol 2023; 16:731-742. [PMID: 37668243 DOI: 10.1080/17474086.2023.2255750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/20/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Immune thrombocytopenia [ITP] is a common bleeding disorder with an isolated platelet count of less than 100 × 109/L. AREAS COVERED Relevant literature from 2003 to 2022 was retrieved and reviewed from the Google Scholar search engine and PubMed database. Antibodies produced by autoreactive B lymphocytes and the phagocytic function of macrophages are considered the most critical factors in platelet destruction. Also, macrophages present the antigen to T lymphocytes and activate them. Follicular helper T-cells [TFH] play a role in stimulating, differentiating, and activating autoreactive B cells, while cluster of differentiation [CD]-8+ T plays a role in platelet destruction through apoptosis. The classical pathway of the complement system also causes platelet destruction. By inhibiting platelet production, low levels of thrombopoietin and an immune response against megakaryocytes in the bone marrow worsen thrombocytopenia. EXPERT OPINION T-cell subset changes and an increase in activated autoreactive B cells, in addition to the function of components of the innate immune system [the complement system, dendritic cells, and natural killer cells], play a critical role in the pathogenesis of the ITP. Accurate detection of these changes may lead to developing new therapeutic strategies and identifying better prognostic/diagnostic factors.
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Affiliation(s)
- Forogh Nokhostin
- Rheumatology Department, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Bakhshpour
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Reyhane Khademi
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Medical Laboratory Sciences, School of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Najmaldin Saki
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Medical Laboratory Sciences, School of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Sorin B, Fadlallah J, Garzaro M, Vigneron J, Bertinchamp R, Boutboul D, Oksenhendler E, Fieschi C, Malphettes M, Galicier L. Real-life use of mTOR inhibitor-based therapy in adults with autoimmune cytopenia highlights strong efficacy in relapsing/refractory multi-lineage autoimmune cytopenia. Ann Hematol 2023:10.1007/s00277-023-05340-0. [PMID: 37386347 DOI: 10.1007/s00277-023-05340-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/25/2023] [Indexed: 07/01/2023]
Abstract
Data on mTOR inhibitors (mTORi) in autoimmune cytopenia (AIC), in adults are scarce. We retrospectively analysed 30 cases of refractory or relapsing AIC treated with an mTORi-based therapy. Eleven warm autoimmune hemolytic anaemia, 10 autoimmune thrombocytopenia, 6 acquired pure red cell aplasia, 3 autoimmune neutropenia were included. Twenty were multilineage AIC (67%) and 21 were secondary AIC (70%). mTORi were associated with other therapies in 23 AIC (77%). Twenty-two AIC (73%) responded to mTORi-based therapy: 5 reached a partial response (17%) and 17 a complete response (57%). Survival without unfavourable outcome (failure, requirement of a new therapy, or death) was longer in multilineage AIC compared to single-lineage AIC (p = 0.049) with a median event-free survival of 48 versus 12 months. Median event-free survival was 48 months in secondary AIC and 33 months in primary AIC (p = 0.79). mTORi were discontinued in 4 patients (15%) for safety reasons and in 3 patients for patient's choice (12%). In conclusion, mTORi could be considered as an alternative or an add-on therapy in refractory or relapsing AIC in adult patients, especially in multilineage AIC.
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Affiliation(s)
- Boris Sorin
- Department of Clinical Immunology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, 1 Avenue Claude Vellefaux, 75010, Paris, France.
| | - Jehane Fadlallah
- Department of Clinical Immunology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Margaux Garzaro
- Department of Clinical Immunology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Julien Vigneron
- Department of Biostatistics and Medical Information, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Rémi Bertinchamp
- Department of Clinical Immunology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - David Boutboul
- Department of Clinical Immunology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Eric Oksenhendler
- Department of Clinical Immunology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Claire Fieschi
- Department of Clinical Immunology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Marion Malphettes
- Department of Clinical Immunology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Lionel Galicier
- Department of Clinical Immunology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, 1 Avenue Claude Vellefaux, 75010, Paris, France
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Yin DM, Yuan D, Sun RJ, Xu HZ, Hun SY, Sui XH, Shan NN. Identification of ORM1, vWF, SPARC, and PPBP as immune-related proteins involved in immune thrombocytopenia by quantitative LC-MS/MS. Clin Proteomics 2023; 20:24. [PMID: 37355563 DOI: 10.1186/s12014-023-09413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/03/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Immune thrombocytopenia (ITP) is a common autoimmune disease characterized by loss of immune tolerance to platelet autoantigens leading to excessive destruction and insufficient production of platelets. METHOD Quantitative liquid chromatography tandem mass spectrometry (LC-MS/MS) was performed to detect the differentially expressed proteins in bone marrow samples from active ITP patients and normal controls. RESULT Our bioinformatic analysis identified two upregulated proteins (ORM1 and vWF) and two downregulated proteins (PPBP and SPARC) related to immune function. The four proteins were all found to be related to the tumor necrosis factor (TNF) -α signalling pathway and involved in the pathogenesis of ITP in KEGG pathway analysis. CONCLUSION Bioinformatics analysis identified differentially expressed proteins in bone marrow that are involved in the TNF-α signalling pathway and are related to the activation of immune function in ITP patients. These findings could provide new ideas for research on the loss of immune tolerance in ITP patients.
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Affiliation(s)
- Dong-Mei Yin
- Department of Blood Transfusion, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, 250021, China
- Department of Blood Transfusion, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Dai Yuan
- Department of Hematology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, 250021, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jing Wu Rd, Jinan, 250021, Shandong, China
| | - Rui-Jie Sun
- Department of Rheumatology, Clinical Immunology Center, Peking Union Medical College Hospital, Beijing, 100000, China
| | - Hong-Zhi Xu
- Department of Hematology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, 250021, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jing Wu Rd, Jinan, 250021, Shandong, China
| | - Shou-Yong Hun
- Department of Blood Transfusion, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, 250021, China
- Department of Blood Transfusion, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Xiao-Hui Sui
- Department of Hematology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, 250021, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jing Wu Rd, Jinan, 250021, Shandong, China
| | - Ning-Ning Shan
- Department of Hematology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, 250021, China.
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jing Wu Rd, Jinan, 250021, Shandong, China.
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Dong Y, Xia Z, Zhou J, Hu Y, Yue M, Wang Y, Hu M. Risk of thrombotic events in immune thrombocytopenia patients treated with thrombopoietic agents: a systematic review and meta-analysis. Thromb J 2023; 21:69. [PMID: 37353791 DOI: 10.1186/s12959-023-00509-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/01/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Immune thrombocytopenia (ITP), which is a well-known hemorrhagic disorder characterized by low platelet counts, has been shown to be associated with the risk of thrombosis. Thrombopoietic agents (TAs) are extensively used as second-line treatments for ITP, effectively reducing the risk of hemorrhage. However, thrombosis, a potential adverse effect of TAs, raises clinical challenges. METHODS The MEDLINE(PubMed), Embase, and the Cochrane Library databases were systematically searched for relevant studies, including both single-arm trials and randomized controlled trials (RCTs), without language restrictions. RESULTS A total of 17 RCTs comprising 2,105 patients and 29 single-arm trials comprising 3,227 patients were included. In the single-arm meta-analysis, the pooled rate of overall thrombotic events in ITP patients receiving TAs was 2.2% (95% CI 1.0% - 3.7%). In RCTs, a higher incidence of thrombosis (33/1425 vs. 4/680) and higher risk ratios (RR) of overall, arterial, and venous thrombotic events (1.73, 95% CI [0.88, 3.39], P = 0.113; RR 1.98, 95% CI [0.80, 4.92], P = 0.141; RR 1.06, 95% CI [0.46, 2.41], P = 0.895, respectively) were observed in the TAs group than in the control group, although the differences were not significant. Subgroup analysis demonstrated that hetrombopag was the only TA with no increased thrombotic risk (rate 0.3% 95% CI [0.0 - 1.5%]; RR 0.76, 95% CI [0.03, 18.41], P = 0.864) compared to eltrombopag, avatrombopag, romiplostim, and rhTPO. Subgroup analyses also revealed that ITP patients with advanced age (3.7% vs. 1.3%, P = 0.132) or with a thrombotic history (3.0% vs. 1.4%, P = 0.257), and patients who received TAs therapy for a long duration (4.7% vs. 0.1%, P < 0.001) had an increased risk of thrombosis. CONCLUSION Our findings suggest ITP patients treated with TAs have a nonsignificantly higher risk of overall, arterial, and venous thrombotic events. Furthermore, hetrombopag is the recommended TA to avoid thrombophilia. Patients receiving long-term TAs, as well as elderly ITP patients or those with a history of thrombosis, face an increased thrombotic risk. In general, clinicians should consider potential thrombotic risks, address underlying risk factors, and ensure ongoing monitoring and follow-up when treating ITP patients with TAs.
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Affiliation(s)
- Yu Dong
- Department of the Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Urology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Zhinan Xia
- Department of Urology, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Jie Zhou
- Department of Basic Medicine College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yutao Hu
- Department of the First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ming Yue
- Department of Basic Medicine College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuyong Wang
- Department of Urology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Mengjiao Hu
- Department of Basic Medicine College, Zhejiang Chinese Medical University, Hangzhou, China.
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Durand P, Pottier V, Mesguich C, Debordeaux F, Lazaro E, Viallard JF, Rivière E. Utility of indium-111 platelet scintigraphy for understanding the mechanism of thrombocytopenia associated with myelodysplastic syndromes and chronic myelomonocytic leukemia. Exp Hematol Oncol 2023; 12:50. [PMID: 37254182 DOI: 10.1186/s40164-023-00414-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/15/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Thrombocytopenia occurs in 60% of patients with myelodysplastic syndromes (MDS), increasing the risk of life-threatening haemorrhage in this population of mainly old patients with comorbidities. However, data are scare regarding immune thrombocytopenia (ITP) secondary to MDS. AIM We analyzed the utility of indium-111 platelet scintigraphy (IPS) to better characterize the mechanisms of thrombocytopenia in 21 adult patients with MDS. METHODS Adult patients with a definite diagnosis of MDS according to the international criteria who underwent IPS between 2009 and 2018 because of an increased bleeding risk were retrospectively selected. Autologous 111Indium platelet labelling was performed with a technique similar to that described previously using a standardized method. RESULTS Platelet lifespan ≤ 6 days identified patients with peripheral platelet destruction. Taking into account the response to ITP-directed therapies after IPS, the sensitivity, specificity, and positive and negative predictive values of IPS were 100%, 84.6%, 80%, and 100%, respectively. CONCLUSION We show that IPS can be a useful tool to identify the mechanism and guide treatment of a chronic thrombocytopenia increasing the bleeding risk in patients with MDS.
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Affiliation(s)
- Pauline Durand
- Department of Internal Medicine and Infectious Diseases, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, 33600, Pessac, France
| | - Valérie Pottier
- Radiopharmacy Department, University Hospital Centre of Bordeaux, Pessac, France
| | - Charles Mesguich
- Radiopharmacy Department, University Hospital Centre of Bordeaux, Pessac, France
- Nuclear Medicine Department, University Hospital Centre of Bordeaux, Pessac, France
- Faculty of Medicine, Bordeaux University, 33000, Bordeaux, France
| | - Frédéric Debordeaux
- Radiopharmacy Department, University Hospital Centre of Bordeaux, Pessac, France
| | - Estibaliz Lazaro
- Department of Internal Medicine and Infectious Diseases, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, 33600, Pessac, France
- UMR CNRS 5164, ImmunoconcEpT and FHU ACRONIM, Bordeaux University, 33000, Bordeaux, France
- Faculty of Medicine, Bordeaux University, 33000, Bordeaux, France
| | - Jean-François Viallard
- Department of Internal Medicine and Infectious Diseases, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, 33600, Pessac, France
- Faculty of Medicine, Bordeaux University, 33000, Bordeaux, France
- INSERM U1034, Bordeaux University, 33604, Pessac Cedex, France
| | - Etienne Rivière
- Department of Internal Medicine and Infectious Diseases, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, 33600, Pessac, France.
- Faculty of Medicine, Bordeaux University, 33000, Bordeaux, France.
- INSERM U1034, Bordeaux University, 33604, Pessac Cedex, France.
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Yamasaki S. Bisphosphonate use for glucocorticoid-induced osteoporosis in older patients with immune thrombocytopenia: a clinical perspective. Ann Hematol 2023:10.1007/s00277-023-05266-7. [PMID: 37171596 PMCID: PMC10175903 DOI: 10.1007/s00277-023-05266-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/06/2023] [Indexed: 05/13/2023]
Abstract
Prednisolone, used as a standard initial treatment for immune thrombocytopenia (ITP), is an important risk factor for osteoporosis. Recently, we found that prescription of bisphosphonate during initial loading of prednisolone may prevent reduction in bone mineral density and development of glucocorticoid-induced osteoporosis (GIO) in older patients with ITP receiving prolonged steroid therapy. In this review, I describe the treatment options for older patients with ITP, and present the best practices for screening, evaluating, and diagnosing ITP. I also summarize the literature from 2017 to 2022 on the treatment options for ITP, including discussions on the contraindications and side effects, with an emphasis on GIO, and the relative merits of bisphosphonates as a co-treatment for prevention of GIO. Finally, I present a perspective and an expert recommendation on how older patients with ITP would best be served in the future.
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Affiliation(s)
- Satoshi Yamasaki
- Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu, Oita, 874-0838, Japan.
- Department of Hematology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, 810-0065, Japan.
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Yang J, Zhao L, Wang W, Wu Y. All-trans retinoic acid added to treatment of primary immune thrombocytopenia: a systematic review and meta-analysis. Ann Hematol 2023:10.1007/s00277-023-05263-w. [PMID: 37166528 DOI: 10.1007/s00277-023-05263-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/05/2023] [Indexed: 05/12/2023]
Abstract
All-trans retinoic acid (ATRA) application is a novel treatment approach for primary immune thrombocytopenia (ITP). This study aimed to evaluate the efficacy and safety of ATRA in the treatment of ITP. The databases of PubMed (MEDLINE), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and China National Knowledge Internet were searched on August 5, 2022, to find randomized controlled trials (RCTs) and observational studies. Five observational studies and four RCTs from China were included, and 760 Chinese patients were analyzed. In the five observational studies, the pooled overall response rate (ORR) and complete response rate (CRR) were 59.5% (95% confidence interval [CI], 52.4-66.4%) and 20.6% (95% CI, 14.3-27.6%), respectively. In the selected four RCTs, the pooled odds ratios for sustained response rate, ORR, and CRR were 3.00 (95% CI, 1.97-4.57; P < 0.01), 3.21 (95% CI, 2.15-4.78; P < 0.01), and 2.12 (95% CI, 1.17-3.86; P = 0.01), respectively. ATRA was associated with a reduction in relapse rate and salvage treatment rate (odds ratio, 0.30; 95% CI, 0.18-0.50; P < 0.01; 0.36; 95% CI, 0.23-0.56; P < 0.01, respectively). The pooled odds ratios for grade 1-2 dry skin, headache (or dizziness), and rash acneiform were 49.99 (95% CI, 16.05-155.67; P < 0.01), 1.75 (95% CI, 0.98-3.12; P = 0.06), and 0.37 (95% CI, 0.10-1.34; P = 0.13), respectively. This study suggests that ATRA may significantly improve the initial and long-term response of patients with ITP.
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Affiliation(s)
- Jinjun Yang
- Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Lei Zhao
- Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Wen Wang
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
| | - Yu Wu
- Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
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Mabrouk RE, Hussein DT, Abbas MEER, Mabood SAE. Sufficient vitamin D is favorable for children with persistent and chronic immune thrombocytopenia. Ann Hematol 2023:10.1007/s00277-023-05210-9. [PMID: 37145323 DOI: 10.1007/s00277-023-05210-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/01/2023] [Indexed: 05/06/2023]
Abstract
Primary immune thrombocytopenia (ITP) is an autoimmune disorder characterized by isolated thrombocytopenia in the absence of other disorders. Vitamin D (VD) has been shown to modulate the immune system and its deficiency is linked to many immunological disorders. Supplementation with VD in ITP has promising results. This work aims at evaluating VD values in children with persistent and chronic ITP and the effect of its deficiency on disease severity and treatment response. A case-control study including 50 persistent and chronic ITP patients and 50 healthy controls was conducted. 25 OH vitamin D level was determined using ELISA technique. VD median value was significantly higher among the control group than that of the patients' group (28 vs 21.5 and p = 0.002). Severe deficiency was detected significantly more among the patients' group than the control group (12 (24%) vs 3 (6%), p = 0.048) respectively. Forty-four percent of complete responders belong to sufficient VD category ((15/34) ~ 44% (p = 0.005)) representing all patients with sufficient VD status (n = 15). Also, a positive correlation between serum level of vitamin D and mean PLT count was observed (r = 0.316, p value = 0.025). Sufficient vitamin D was associated with better treatment response and less disease severity. Vitamin D supplementation may be a new therapeutic option for chronic ITP.
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Affiliation(s)
- Rafae El Mabrouk
- Pediatric Department, Al-Thawra Teaching Hospital, Omar Al-Mukhtar University, Al Bayda, Libya
| | - Dalia Tawfeek Hussein
- Medical Analysis & Biochemistry, Faculty of Medicine, Mansoura University Children Hospital, Mansoura University, Mansoura, Egypt
| | - Mohammed Ezz El Regal Abbas
- Pediatric Department, Faculty of Medicine, Mansoura University Children Hospital, Mansoura University, Mansoura, Egypt
| | - Suzy Abd El Mabood
- Pediatric Hematology, Oncology and Bone Marrow Transplantation Unit, Faculty of Medicine, Mansoura University Children Hospital, Mansoura University, Mansoura, 35516, Egypt.
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Huang CE, Chen YY, Chang JJ, Wu YY, Chen WM, Wang YH, Chen MC, Lu CH, Shi CS, Chen CC. The Impact of Human Platelet Antigen Allele on Antiplatelet Antibodies and Cryoglobulins in Patients with Primary Immune Thrombocytopenia and Hepatitis C Virus-Associated Immune Thrombocytopenia. Mediterr J Hematol Infect Dis 2023; 15:e2023030. [PMID: 37180208 PMCID: PMC10171212 DOI: 10.4084/mjhid.2023.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/20/2023] [Indexed: 05/16/2023] Open
Abstract
Background And Objectives Human platelet antigens (HPAs) are alloantigens associated with antiplatelet alloantibodies and the risk of immune thrombocytopenia (ITP). However, few studies have investigated associations among HPAs, antiplatelet autoantibodies, and cryoglobulins. Methods We enrolled 43 patients with primary ITP, 47 with hepatitis C virus-associated ITP (HCV-ITP), 21 with hepatitis B virus-associated ITP (HBV-ITP), 25 controls with HCV, and 1013 normal controls. We analyzed HPA allele frequencies, including HPA1-6 and 15, antiplatelet antibodies binding to platelet glycoprotein (GP) IIb/IIIa, Ia/IIa, Ib/IX, IV, human leukocyte antigen class I, cryoglobulin IgG/A/M, and their associations with thrombocytopenia. Results In the ITP cohort, HPA2ab, rather than HPA2aa, predicted a low platelet count. HPA2b was associated with the risk of developing ITP. HPA15b was correlated with multiple antiplatelet antibodies. In HCV-ITP patients, HPA3b was correlated with anti-GPIIb/IIIa antibodies. HCV-ITP patients with anti-GPIIb/IIIa antibodies had a higher positive rate of cryoglobulin IgG and IgA compared with those without anti-GPIIb/IIIa antibodies. Overlapping detection was also found among other antiplatelet antibodies and cryoglobulins. Like the antiplatelet antibodies, cryoglobulins were associated with clinical thrombocytopenia, implying their close relationship. Finally, we extracted cryoglobulins to confirm the exhibition of cryoglobulin-like antiplatelet antibodies. In contrast, in primary ITP patients, HPA3b was correlated with cryoglobulin IgG/A/M rather than anti-GPIIb/IIIa antibodies. Conclusion HPA alleles were associated with antiplatelet autoantibodies and had different impacts in primary ITP and HCV-ITP patients. HCV-ITP was considered to be a symptom of mixed cryoglobulinemia in HCV patients. The pathophysiology may differ between these two groups.
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Affiliation(s)
- Cih-En Huang
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Yang Chen
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jung-Jung Chang
- Division of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Ying Wu
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei-Ming Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ying-Hsuan Wang
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Min-Chi Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Public Health and Biostatistics Consulting Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chang-Hsien Lu
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chung-Sheng Shi
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Cheng Chen
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Wu F, She Z, Li C, Mao J, Luo S, Chen X, Tian J, Wen C. Therapeutic potential of MSCs and MSC-derived extracellular vesicles in immune thrombocytopenia. Stem Cell Res Ther 2023; 14:79. [PMID: 37041587 PMCID: PMC10091587 DOI: 10.1186/s13287-023-03323-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/29/2023] [Indexed: 04/13/2023] Open
Abstract
Immune thrombocytopenia (ITP) is an acquired autoimmune disease involving a variety of immune cells and factors. Despite being a benign disease, it is still considered incurable due to its complex pathogenesis. Mesenchymal stem cells (MSCs), with low immunogenicity, pluripotent differentiation, and immunomodulatory ability, are widely used in a variety of autoimmune diseases. In recent years, impaired bone marrow mesenchymal stem cells (BMMSCs) were found to play an important role in the pathogenesis of ITP; and the therapeutic role of MSCs in ITP has also been supported by increasing evidence with encouraging efficacy. MSCs hold promise as a new approach to treat or even cure refractory ITP. Extracellular vesicles (EVs), as novel carriers in the "paracrine" mechanism of MSCs, are the focus of MSCs. Encouragingly, several studies suggested that EVs may perform similar functions as MSCs to treat ITP. This review summarized the role of MSCs in the pathophysiology and treatment of ITP.
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Affiliation(s)
- Feifeng Wu
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Zhou She
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Cuifang Li
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Jueyi Mao
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Senlin Luo
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Xiaoyu Chen
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Jidong Tian
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Chuan Wen
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
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Li T, Liu Q, Pu T, Liu J, Zhang A. Efficacy and safety of thrombopoietin receptor agonists in children and adults with persistent and chronic immune thrombocytopenia: a meta-analysis. Expert Opin Pharmacother 2023; 24:763-774. [PMID: 37010022 DOI: 10.1080/14656566.2023.2198089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
INTRODUCTION In this paper, we systematically review the efficacy and safety of thrombopoietin receptor agonists (TPORAs) for treatment of persistent and chronic immune thrombocytopenia (ITP) in children and adults. METHODS We searched PubMed, MEDLINE, ScienceDirect, Scopus, EMbase and the Cochrane Library to collect randomized controlled trials (RCTs) of TPO-RAs which including avatrombopag hetrombopag eltrombopag and romiplostim treated persistent and chronic ITP from their earliest records to February 2022. RESULTS We included 15 RCTs with a total of 1563 patients. There were ten trials of adults and five trials of children. The results of meta-analysis showed that in adult patients, patients treated with TPO-RAs had longer duration of platelet response, higher platelet response rate, lower use of rescue therapy, and lower incidence of bleeding events, and similar incidence of adverse events compared with placebo. Except for the incidence of any bleeding, the results in children were consistent with those in adults. The network meta-analysis of data on overall platelet response rates in adults showed that avatrombopag was more effective than eltrombopag and hetrombopag. CONCLUSIONS TPO-RAs has better efficacy and higher safety in the treatment of ITP. And the overall response rate of avatrombopag in adults was higher than that in eltrombopag and hetrombopag.
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Affiliation(s)
- Ting Li
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan 250000, China
| | - Qinqin Liu
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan 250000, China
| | - Ting Pu
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan 250000, China
| | - Jing Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicin, Shandong University, Jinan 250012, China
| | - Aijun Zhang
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan 250000, China
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50
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Chen HY, Lee WK, Chang R, Hung YM, Hsu CY, Shih YH, Chen JS. Immune thrombocytopenia and risk of stroke: Evidence from a nationwide population-based cohort study. Int J Stroke 2023; 18:408-415. [PMID: 36073612 DOI: 10.1177/17474930221125556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research investigating differences in the overall stroke risk between individuals with and without immune thrombocytopenia (ITP) is lacking. METHODS This real-world study used the National Health Insurance Research Database (NHIRD). Risk of stroke was compared between 13,085 individuals with ITP enrolled between 1 January 2000 and 31 December 2015 and a control cohort of 52,340 individuals without ITP (1:4 ratio propensity score-matched by age, sex, index year, relevant comorbidities, and medications). Sub-distribution hazards models were used to estimate adjusted sub-distribution hazard ratio (SHR) and 95% confidence intervals (CIs), with the non-ITP group as the control group. RESULTS Of the 65,425 participants, 13,085 had ITP, 63.3% were women, and the mean age was 52.59 years. The risk of both ischemic and hemorrhagic stroke was 1.14 times (adjusted SHR 1.14, 95% CI, 1.07-1.22) and 1.93 times (adjusted SHR 1.93, 95% CI, 1.70-2.20) higher in the ITP group than in controls. Patients with ITP in the 20- to 29-year subgroup had a higher risk of new-onset stroke (adjusted SHR, 4.06 (95% CI, 2.72-6.07), p value for interaction <0.01) than those aged 20-29 years without ITP. Individuals with severe ITP with splenectomy had a 1.79 times higher overall stroke risk than those without. CONCLUSIONS ITP is associated with increased risk of both ischemic and hemorrhagic stroke.
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Affiliation(s)
- Hsin-Yu Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Wei-Kai Lee
- Department of Emergency Medicine, Sinying Hospital, Ministry of Health and Welfare, Tainan
- Min-Hwei Junior College of Health Care Management, Tainan
| | - Renin Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Yao-Min Hung
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung
- College of Health and Nursing, Meiho University, Pingtung
- Institute of Medicine, Chung Shan Medical University, Taichung
| | - Chung Y Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung
| | - Ying-Hsiu Shih
- Management Office for Health Data (DryLab), Clinical Trial Research Center (CTC), China Medical University Hospital, Taichung
| | - Jin-Shuen Chen
- Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung
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