Chronic lymphocytic leukemia‐associated immune thrombocytopenia treated with rituximab: a retrospective study of 21 patients

D’Arena, Giovanni; Capalbo, Silvana; Laurenti, Luca; Poeta, Giovanni Del; Nunziata, Giuseppe; Deaglio, Silvia; Spinosa, Giuseppina; Tarnani, Michela; Padua, Laura De; Califano, Catello; Ferrara, Felicetto; Cascavilla, Nicola

doi:10.1111/j.1600-0609.2010.01527.x

Cited by 23 publications

(14 citation statements)

References 30 publications

(46 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…71,82 There are case reports of the use of combinations of the anti-CD20 monoclonal antibody rituximab with or without immunosuppression with good effect. [83][84][85][86][87] The anti-CD52 monoclonal antibody alemtuzumab has also been successfully used. [88][89][90] Intravenous immunoglobulin can be useful where a rapid response is needed (e.g.…”

Section: Diagnosis and Managementmentioning

confidence: 99%

“…81 However, patients with active AIHA or ITP are still excluded from clinical trials, and given the ongoing concerns about using fludarabine in this setting, alternative regimens which do not feature fludarabine have also been explored (Table 3). 87,[92][93][94] Importantly, after successful treatment, patients with stage C "immune" may be "down-staged" to Binet stage A and thus no longer fulfill the criteria for initiation of treatment for CLL. This makes a clear understanding of the origin of cytopenia in a patient with CLL even more important before a decision about treatment is made.…”

Section: Diagnosis and Managementmentioning

confidence: 99%

See 1 more Smart Citation

Chronic lymphocytic leukemia and autoimmunity: a systematic review

Hodgson¹,

Ferrer²,

Montserrat³

et al. 2011

Haematologica

120

View full text Add to dashboard Cite

Section: Diagnosis and Managementmentioning

confidence: 99%

Section: Diagnosis and Managementmentioning

confidence: 99%

Chronic lymphocytic leukemia and autoimmunity: a systematic review

Hodgson¹,

Ferrer²,

Montserrat³

et al. 2011

Haematologica

120

View full text Add to dashboard Cite

“…57 The overall response rate was 86% (57% CR, 29% PR), with a mean duration of response of 21 months. At a mean follow-up of 28 months, 66% of patients were still alive, 48% of them in CR and 14% in PR.…”

Section: Monoclonal Antibodiesmentioning

confidence: 93%

The Use of Monoclonal Antibodies in the Treatment of Autoimmune Complications of Chronic Lymphocytic Leukemia

Laurenti¹

2013

Mediterr J Hematol Infect Dis

Self Cite

View full text Add to dashboard Cite

Autoimmune cytopenias are a frequent complication in CLL, occurring in approximately 5–10% of the patients. The most common manifestation is autoimmune haemolytic anaemia, followed by immune thrombocytopenia and only rarely pure red blood cell aplasia or autoimmune granulocytopenia. Initial treatment is as for the idiopathic autoimmune cytopenias, with most patients responding to conventional corticosteroid therapy. Patients, who do not respond to conventional therapy after 4–6 weeks, should be considered for alternative immunosuppression, monoclonal antibody therapy or splenectomy. While randomized trials demonstrating the benefit of rituximab in CLL-related autoimmune diseases are still lacking, there are considerable data in the literature that provide evidence for its effectiveness.The monoclonal antibody alemtuzumab also displays considerable activity against both the malignant disease and the autoimmune complication in patients with CLL, although at the expense of greater toxicity. A number of new monoclonal antibodies, such as ofatumumab, GA-101, lumiliximab, TRU-016, epratuzumab, and galiximab, are currently investigated in CLL and their activity in CLL-related autoimmune cytopenias should be evaluated in future studies.

show abstract

“…Rituximab,57 Alemtuzumab58 and Veltuzumab59 have been reported to be effective in CLL associated AIT 60,61. Most of the published literature about rituximab is in primary immune thrombocytopenic purpura.…”

Section: Managementmentioning

confidence: 99%

Autoimmune Cytopenias in Chronic Lymphocytic Leukemia, Facts and Myths

Tandra

Krishnamurthy

Bhatt

et al. 2013

Mediterr J Hematol Infect Dis

View full text Add to dashboard Cite

CLL has been defined as presence of more than 5000 small mature appearing monoclonal B lymphocytes with a specific immunophenotype in peripheral blood. It is a well-known fact that CLL is associated with autoimmune cytopenias. CLL cells are CD5+ B lymphocytes, and usually are not the “guilty” cells which produce autoantibodies. T cell defect is another characteristic of CLL and the total number of T cells is increased, and there is inversion of the CD4/CD8 ratio. Autoimmune hemolytic anemia (AIHA) is the most common autoimmune complication of CLL and has been reported in 10–25% of CLL patients. However, the stage-adjusted estimated rate of AIHA in CLL is about 5%. Conversely, CLL is three times more common in patients who present with AIHA. Direct agglutinin test (DAT) is positive in 7–14% of CLL patients but AIHA may also occur in DAT negative patients.Autoimmune thrombocytopenia (AIT) is the second most common complication of CLL and has been reported in 2–3% of patients. DAT is positive in AIT but presence of antiplatelet antibodies is neither diagnostic nor reliable. Autoimmune neutropenia (AIN) and pure red cell aplasia (PRCA) are very rare complications of CLL and like other autoimmune complications of CLL may occur at any clinical stage. It is believed that most case reports of AIN and PRCA in CLL actually belong to large granular lymphocytic leukemia (LGL). Non-hematologic autoimmune complications of CLL including cold agglutinin disease (CAD), paraneoplastic pemphigus (PNP), acquired angioedema, and anti-myelin associated globulin are rare.Before starting any treatment, clinicians should distinguish between autoimmune cytopenias and massive bone marrow infiltration since autoimmune complications of CLL are not necessarily equal to advanced disease with poor prognosis. According to IWCLL guideline, steroids are the mainstay of treatment of simple autoimmunity. Intravenous immunoglobulin (IVIg), cyclosporine, and rituximab are used in complex, steroid refractory cases. Monotherapy with purine analogues and alkylating agents should be avoided as they may increase CLL associated autoimmune complications.

show abstract

Chronic lymphocytic leukemia‐associated immune thrombocytopenia treated with rituximab: a retrospective study of 21 patients

Abstract: This retrospective analysis prove that rituximab is an effective and well-tolerated alternative treatment for CLL-associated IT.

Cited by 23 publications

References 30 publications

Chronic lymphocytic leukemia and autoimmunity: a systematic review

Chronic lymphocytic leukemia and autoimmunity: a systematic review

The Use of Monoclonal Antibodies in the Treatment of Autoimmune Complications of Chronic Lymphocytic Leukemia

Autoimmune Cytopenias in Chronic Lymphocytic Leukemia, Facts and Myths

Contact Info

Product

Resources

About