Eltrombopag for resistant immune thrombocytopenia secondary to chronic lymphocytic leukaemia

Jolliffe, Evan; Romeril, Kenneth

doi:10.1111/imj.12468

Cited by 8 publications

(9 citation statements)

References 16 publications

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“…49,50 These agents have also shown durable responses in patients with refractory CLL-associated ITP, and may be considered in patients with minimal CLL disease burden and unremitting severe thrombocytopenia. 51,52 Jain et al 53 demonstrated in their enrolling phase II trial of eltrombopag that at varying doses, eltrombopag produced an overall response in 55% of all patients with thrombocytopenia, either due to CLL-associated ITP or CLL marrow infiltration. Overall, both groups of patients had a 45% complete response (CR) or 9% major response (MR).…”

Section: Immune Thrombocytopeniamentioning

confidence: 99%

A Concise Review of Autoimmune Cytopenias in Chronic Lymphocytic Leukemia

Tsang

2017

Curr Hematol Malig Rep

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Chronic lymphocytic leukemia (CLL) is frequently associated with autoimmune complications such as autoimmune hemolytic anemia, immune thrombocytopenia, pure red cell aplasia and autoimmune granulocytopenia. It is critical to diagnose cytopenias from these secondary complications of CLL accurately, since prognosis and therapy are substantially different from patients who have cytopenias due to extensive bone marrow infiltration by CLL. The pathogenesis of autoimmune cytopenias in CLL is complex; and involves antigen presentation by CLL cells to polyclonal B-cells resulting in production of autoantibody and alteration of the T-cell milieu tilting the balance in favor of an autoimmune response. Traditional therapy of autoimmune complications in CLL consists of immunosuppression with corticosteroids and/or anti-CD20 monoclonal antibodies. In patients who have a suboptimal response, treating the underlying CLL is generally effective in ameliorating secondary cytopenias. Although novel oral therapies such as ibrutinib, idelalisib and venetoclax have been shown to be extremely effective in the management of CLL; prospective data from larger numbers of patients with longer follow-up are needed prior to recommending their routine use in the management of autoimmune cytopenias in CLL.

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Section: Immune Thrombocytopeniamentioning

confidence: 99%

A Concise Review of Autoimmune Cytopenias in Chronic Lymphocytic Leukemia

Tsang

2017

Curr Hematol Malig Rep

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“…Also, eltrombopag is currently approved by the US Food and Drug Administration and the European Medicines Agency for the treatment of thrombocytopenia secondary to aplastic anaemia (Olnes et al, 2012) and thrombocytopenia secondary to hepatitis C infection (McHutchison et al, 2007;Afdhal et al, 2012). Eltrombopag has also been successfully used in a very small number of patients with immune thrombocytopenia secondary to chronic lymphatic leukaemia (Koehrer et al, 2010;Sinisalo et al, 2011;Gudbrandsdottir et al, 2012;Jolliffe & Romeril, 2014;Chang & Shih, 2015), systemic lupus erythematosus (SLE: Chang & Shih, 2015;Gonzalez-Nieto et al, 2011;Alkaabi et al, 2012;Scheinberg et al, 2014;Magnano et al, 2014;Maroun et al, 2015), Evans syndrome (Gonzalez-Nieto et al, 2011;Alkaabi et al, 2012;Ruiz-Arguelles et al, 2013;Magnano et al, 2014;Scheinberg et al, 2014;Chang & Shih, 2015;Maroun et al, 2015), human immunodeficiency virus (Quach et al, 2012;Aslam et al, 2014;Chang & Shih, 2015;Kowalczyk et al, 2015) and coeliac disease (Chang & Shih, 2015) who had a loss of response to standard treatment for ITP. The communication of such cases is essential to support the potential utility of eltrombopag as salvage therapy in the treatment of secondary immune thrombocytopenia.…”

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confidence: 99%

Use of eltrombopag for secondary immune thrombocytopenia in clinical practice

et al. 2017

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

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“…Data are also reported about the use of TPO‐RAs for the treatment of thrombocytopenia related to hematologic, autoimmune, and infectious diseases, or to chemotherapy . In particular, the use of eltrombopag in chronic lymphocytic leukemia (CLL) associated ITP was described by different authors : in two cases, a CR was obtained and one patient could stop the drug ; in one case, eltrombopag was successfully used preoperatively to increase the platelet count to allow laparoscopic splenectomy ; in one other case, eltrombopag increased platelet count to normal range 13 days after treatment start in a patient who presented recurrent ITP associated to pulmonary hemorrhage . Al‐Nawakil et al reported the use of romiplostim in four ITP patients during the diagnostic phase or after diagnosis of lymphomas: 3/4 patients obtained a response.…”

Section: Discussionmentioning

confidence: 99%

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

Santoro

Volpicelli

Baldacci

et al. 2017

Clinical Case Reports

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

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Eltrombopag for resistant immune thrombocytopenia secondary to chronic lymphocytic leukaemia

Cited by 8 publications

References 16 publications

A Concise Review of Autoimmune Cytopenias in Chronic Lymphocytic Leukemia

A Concise Review of Autoimmune Cytopenias in Chronic Lymphocytic Leukemia

Use of eltrombopag for secondary immune thrombocytopenia in clinical practice

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

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