Immune thrombocytopenia management during COVID‐19 pandemic: An Italian monocentric experience

Lapietra, Gianfranco; Ferretti, Antonietta; Baldacci, Erminia; Chistolini, Antonio; Santoro, Cristina

doi:10.1002/jha2.406

Cited by 6 publications

(4 citation statements)

References 16 publications

(26 reference statements)

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“…Infections are one of the well-known precipitating factors for relapses and exacerbations in pts with ITP. Very few studies focusing on the effect of COVID-19 infection in chronic ITP patients have been published [ 5 , 6 , 7 , 8 , 9 , 20 , 21 ] with divergent conclusions and an unclear distinction between de novo ITP and previous/chronic ITP. One of the largest studies [ 7 ] reported the outcome of 32 pts with a pre-existing ITP with COVID-19 infection reporting a reduction in plt count in 47% of the pts, all requiring treatment or a modification of current ITP treatment.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 Infection, Vaccination, and Serological Response in Immune Thrombocytopenic Purpura Patients: A Single-Center Global Analysis

Dainese¹,

Valeri²,

Bardetta³

et al. 2022

Biomedicines

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Both SARS-CoV-2 infection and vaccination have raised concern in immune-mediated diseases, including immune thrombocytopenic purpura (ITP) considering risk of de novo ITP development and ITP recurrence. Here, we report on data from a single-center retrospective–prospective collection aiming to evaluate platelet (plt) dynamics in patients (pts) with chronic ITP after COVID-19 infection (before and after vaccination) and after the first, second and third vaccine doses. Furthermore, we analyzed the serological response after the first two doses of COVID-19 vaccination. A total of 64 pts currently followed for chronic ITP who experienced COVD-19 infection and/or vaccination with an available plt count before and after such events were included in the analysis. A low incidence of ITP exacerbation following vaccine sessions (6–16%) was observed in comparison with a high frequency of exacerbation and rescue treatment necessity after COVID-19 infection in unvaccinated pts (83%). Moreover, the lower ITP exacerbation rate observed in infected pts previously vaccinated (18%) suggests further protective effects in this population. Finally, a high seroconversion rate was observed, confirming data reported in previously published studies on immune cytopenia and rheumatological diseases, but more evidence is awaited to establish the clinical impact of serological response.

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Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 Infection, Vaccination, and Serological Response in Immune Thrombocytopenic Purpura Patients: A Single-Center Global Analysis

Dainese¹,

Valeri²,

Bardetta³

et al. 2022

Biomedicines

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“…If the infection leads to a relapse of the thrombocytopenia, patients should be administered IVIg if the drop in platelet counts is severe, and platelets should be transfused in the event of bleeding. In those patients who are already being treated with a TPO-RA, an increase in the dose or the addition of another TPO-RA or fostamatinib could be proposed [130,134].…”

Section: Itp and Covid-19mentioning

confidence: 99%

Recommendations for the Clinical Approach to Immune Thrombocytopenia: Spanish ITP Working Group (GEPTI)

Mingot-Castellano,

Canaro Hirnyk,

Sánchez-González

et al. 2023

JCM

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Primary immune thrombocytopenia (ITP) is a complex autoimmune disease whose hallmark is a deregulation of cellular and humoral immunity leading to increased destruction and reduced production of platelets. The heterogeneity of presentation and clinical course hampers personalized approaches for diagnosis and management. In 2021, the Spanish ITP Group (GEPTI) of the Spanish Society of Hematology and Hemotherapy (SEHH) updated a consensus document that had been launched in 2011. The updated guidelines have been the reference for the diagnosis and management of primary ITP in Spain ever since. Nevertheless, the emergence of new tools and strategies makes it advisable to review them again. For this reason, we have updated the main recommendations appropriately. Our aim is to provide a practical tool to facilitate the integral management of all aspects of primary ITP management.

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“…Further, in in vitro and in a humanized mouse model of graft versus host disease (GvHD), it was described that BM-MSCs affected T lymphocyte proliferation more than UC-MSCs, while the latter induced a higher increase of Tregs/Th17 ratio [ 219 ]. Since Treg/Th17 ratio imbalance correlates with immune thrombocytopenia (ITP) [ 220 ] and this imbalanced ratio was also observed in different cases of COVID-19 disease [ 221 ], the reactions of infused MSCs for correcting immune response in such condition should be absolutely taken in consideration. For example, the patients with ITP displayed abnormalities in BM-MSCs, due to defects in mRNA and miRNA that induced downregulation of genes involved in cellular stress machinery, such as the unfolded protein response (UPR), the nuclear protein transcriptional regulator 1 (Nupr1), involved in endoplasmic reticulum pathway, the TGF-β1 signaling, leading to a loss of immunosuppressive properties, and a breakdown of self-tolerance in ITP patients [ 222 ].…”

Section: Mscs In Covid-19 Patients: Are Uc-mscs Better Than the “Gold...mentioning

confidence: 99%

Facing the Challenges in the COVID-19 Pandemic Era: From Standard Treatments to the Umbilical Cord-Derived Mesenchymal Stromal Cells as a New Therapeutic Strategy

Russo

Corrao

Gaudio

et al. 2023

Cells

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Coronavirus disease 2019 (COVID-19), the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which counts more than 650 million cases and more than 6.6 million of deaths worldwide, affects the respiratory system with typical symptoms such as fever, cough, sore throat, acute respiratory distress syndrome (ARDS), and fatigue. Other nonpulmonary manifestations are related with abnormal inflammatory response, the “cytokine storm”, that could lead to a multiorgan disease and to death. Evolution of effective vaccines against SARS-CoV-2 provided multiple options to prevent the infection, but the treatment of the severe forms remains difficult to manage. The cytokine storm is usually counteracted with standard medical care and anti-inflammatory drugs, but researchers moved forward their studies on new strategies based on cell therapy approaches. The perinatal tissues, such as placental membranes, amniotic fluid, and umbilical cord derivatives, are enriched in mesenchymal stromal cells (MSCs) that exert a well-known anti-inflammatory role, immune response modulation, and tissue repair. In this review, we focused on umbilical-cord-derived MSCs (UC-MSCs) used in in vitro and in vivo studies in order to evaluate the weakening of the severe symptoms, and on recent clinical trials from different databases, supporting the favorable potential of UC-MSCs as therapeutic strategy.

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Immune thrombocytopenia management during COVID‐19 pandemic: An Italian monocentric experience

Cited by 6 publications

References 16 publications

Impact of COVID-19 Infection, Vaccination, and Serological Response in Immune Thrombocytopenic Purpura Patients: A Single-Center Global Analysis

Impact of COVID-19 Infection, Vaccination, and Serological Response in Immune Thrombocytopenic Purpura Patients: A Single-Center Global Analysis

Recommendations for the Clinical Approach to Immune Thrombocytopenia: Spanish ITP Working Group (GEPTI)

Facing the Challenges in the COVID-19 Pandemic Era: From Standard Treatments to the Umbilical Cord-Derived Mesenchymal Stromal Cells as a New Therapeutic Strategy

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