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Lakhwani S, López‐Las Heras A, Rodríguez‐García P, Iraheta S, Martín‐Santos T, Rodríguez‐Salazar MJ, Machado P, Hernández M. Intramuscular Anti-D treatment for immune thrombocytopenia: A single centre experience. Br J Haematol 2023; 200:353-357. [PMID: 36198407 PMCID: PMC10091692 DOI: 10.1111/bjh.18484] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 01/21/2023]
Abstract
Intravenous Anti-Rhesus-D immunoglobulin (Anti-D) is a first-line treatment option for immune thrombocytopenia in non-splenectomised and RhD-positive patients. In this report, we retrospectively review our experience with intramuscular (IM) Anti-D treatment in 74 adult patients between 1990 and 2018. We found that 73% of patients showed a response; almost all of them had complete responses (68.9%), and 26% achieved complete responses sustained at least 6 months after treatment discontinuation. [Correction added on 02 December 2022, after first online publication: In the preceding sentence, '(68.89%)' has been corrected to '(68.9%)' in this version.] No significant side effects were observed with no cases of acute haemolysis or anaemia reported. We conclude from this study that IM Anti-D is an effective and safe treatment for immune thrombocytopenia.
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Affiliation(s)
- Sunil Lakhwani
- Department of HematologyHospital Universitario de CanariasLa LagunaSpain
- Department of Internal MedicinePsychiatry and Dermatology, La Laguna UniversityLa LagunaSpain
| | - Alberto López‐Las Heras
- Department of Internal MedicinePsychiatry and Dermatology, La Laguna UniversityLa LagunaSpain
| | - Pablo Rodríguez‐García
- Department of Internal MedicinePsychiatry and Dermatology, La Laguna UniversityLa LagunaSpain
| | - Sandra Iraheta
- Department of HematologyHospital Universitario de CanariasLa LagunaSpain
| | | | | | - Patricia Machado
- Department of HematologyHospital Universitario de CanariasLa LagunaSpain
| | - Miguel‐Teodoro Hernández
- Department of HematologyHospital Universitario de CanariasLa LagunaSpain
- Department of Internal MedicinePsychiatry and Dermatology, La Laguna UniversityLa LagunaSpain
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Primo D, Scarfò L, Xochelli A, Mattsson M, Ranghetti P, Espinosa AB, Robles A, Gorrochategui J, Martínez-López J, de la Serna J, González M, Gil AC, Anguita E, Iraheta S, Munugalavadla V, Quéva C, Tannheimer S, Rosenquist R, Stamatopoulos K, Ballesteros J, Ghia P. A novel ex vivo high-throughput assay reveals antiproliferative effects of idelalisib and ibrutinib in chronic lymphocytic leukemia. Oncotarget 2018; 9:26019-26031. [PMID: 29899839 PMCID: PMC5995261 DOI: 10.18632/oncotarget.25419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 08/13/2017] [Accepted: 04/28/2018] [Indexed: 12/21/2022] Open
Abstract
PI3Kδ (idelalisib) and BTK (ibrutinib) inhibitors have demonstrated significant clinical activity in chronic lymphocytic leukemia (CLL) interfering with the cross-talk between CLL cells and the lymph node microenviroment, yet their mechanism of action remains to be fully elucidated. Here, we developed an ex vivo model with the aim of reproducing the effects of the microenvironment that would help shed light on the in vivo mechanism of action of idelalisib and ibrutinib and predict their clinical efficacy in individual patients. First we explored the effects of various cell-extrinsic elements on CLL apoptosis and proliferation and found that the combination of CpG+IL2+HS5 stromal cell line + human serum +CLL plasma and erythrocyte fractions represented the best co-culture conditions to test the effects of the novel inhibitors. Then, using this assay, we investigated the impact of idelalisib and ibrutinib on both survival and proliferation in 30 CLL patients. While both drugs had a limited direct pro-apoptotic activity, a potent inhibition of proliferation was achieved at clinically achievable concentrations. Notably, up to 10% of CLL cells still proliferated even at the highest concentrations, likely mirroring the known difficulty to achieve complete responses in vivo. Altogether, this novel assay represents an appropriate ex vivo drug testing system to potentially predict the clinical response to novel inhibitors in particular by quantifying the antiproliferative effect.
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Affiliation(s)
| | - Lydia Scarfò
- Strategic Research Program on CLL and B Cell Neoplasia Unit, Università Vita-Salute San Raffaele and IRCCS Istituto Scientifico San Raffaele, Milan, Italy
| | - Aliki Xochelli
- Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece
| | - Mattias Mattsson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Pamela Ranghetti
- Strategic Research Program on CLL and B Cell Neoplasia Unit, Università Vita-Salute San Raffaele and IRCCS Istituto Scientifico San Raffaele, Milan, Italy
| | | | | | | | | | - Javier de la Serna
- Department of Hematology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Marcos González
- Hematology Service, IBSAL-Hospital Universitario, Centro de Investigación del Cáncer (CIC)- IBMCC, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Universidad de Salamanca, Salamanca, Spain
| | - Alberto Chaparro Gil
- Department of Hematology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.,Department of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Eduardo Anguita
- Department of Hematology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.,Department of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Sandra Iraheta
- Department of Hematology and Hemotherapy, Hospital Universitario de Canarias, La Laguna, Spain
| | | | | | | | - Richard Rosenquist
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece.,Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - Paolo Ghia
- Strategic Research Program on CLL and B Cell Neoplasia Unit, Università Vita-Salute San Raffaele and IRCCS Istituto Scientifico San Raffaele, Milan, Italy
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