Is Autoimmune Thrombocytopenia Itself the Primary Disease in the Presence of Second Diseases Data from a Long-Term Observation

Aboud, Nasra; Depré, Fabian; Salama, Abdulgabar

doi:10.1159/000449038

Cited by 9 publications

(6 citation statements)

References 42 publications

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“…Initially, most patients appeared to have isolated ITP. During observation, at least 57% (n = 227) of our patients exhibited other abnormalities e.g., DAT positivity, antibody deficiency, malignancies, or other diseases and abnormalities, Based on our experiences [ 53 ], the common classification into a primary and a secondary disease is not certain and variable in many cases. Moreover, the ITP itself might be responsible for the development of associated diseases at least in some cases.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and tolerability of old and new drugs used in the treatment of immune thrombocytopenia: Results from a long-term observation in clinical practice

et al. 2018

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BackgroundMany patients with immune thrombocytopenia (ITP) may require special attention and long-term treatment. Little is known on the efficacy and tolerability of the drugs used in practice.Material and methodsWe retrospectively reviewed the results of therapy of 400 patients with chronic ITP. All Patients were treated at our institution between 1996–2016 under consideration of guidelines, general recommendations, and individual aspects, including gender, age, weight, comorbidity, patient’s medical history and bleeding risk.ResultsTreatment was not required in 25% of patients (n = 100) during observation. In treated patients (n = 300), the rate of patients that responded and tolerated treatment with prednisolone was 59% (52/88), with azathioprine 32% (29/90), with eltrombopag 49% (31/63), with romiplostim 59% 27/45, with IVIG (intravenous immunoglobulines) 75% (94/126), with anti-D 37% (19/52) and with dexamethasone 60% (25/42) patients. Eighteen treated patients (6%) entered sustained remission after treatment with various drugs. Twenty-six patients underwent splenectomy (Splx) resulting in sustained remission in 15 cases (60%). Only two patients remained refractory to Splx and to all used drugs.DiscussionNone of the currently available drugs used in the treatment of ITP are invariably safe and effective. Responses, the duration of response, intolerability, and the course of disease are unpredictable. Although the treatment of ITP has considerably improved in the recent years, the currently available drugs may rarely cure affected patients. The need for safe and effective therapy in ITP is evident. Optimal treatment decisions for each patient remains a challenge in many cases.

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Section: Discussionmentioning

confidence: 99%

Efficacy and tolerability of old and new drugs used in the treatment of immune thrombocytopenia: Results from a long-term observation in clinical practice

et al. 2018

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“…Evans syndrome or lupus erythematodes [13]. Aboud and coworkers [13] could show in a large retrospective analysis that 11% of patients with autoimmune thrombocytopenia suffered from affections of the thyroid gland just as well as the patient presented here who had developed Hashimoto thyreoiditis under therapy with IFN-α in the past. In general, autoimmune disorders tend to coexist in the same individual [14].…”

Section: Discussionmentioning

confidence: 54%

“…Autoimmune thrombocytopenia can be classified into a primary or a secondary form, dependent on the absence or presence of associated or underlying diseases [13]. The secondary form may be associated with infections, e.g.…”

Section: Discussionmentioning

confidence: 99%

A Case of Immune Thrombocytopenia as a Rare Side Effect of an Immunotherapy with PD1-Blocking Agents for Metastatic Melanoma

Pföhler

Eichler

Burgard

et al. 2017

Transfus Med Hemother

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Background: Checkpoint blocking agents such as pembrolizumab or nivolumab may induce a diversity of mostly autoimmune-mediated side effects. These autoimmune phenomena mainly affect ductless glands such as the pituitary gland (hypophysitis), the thyroid gland (thyreoiditis), the skin (vitiligo and rash), the colon (colitis), and the lung (pneumonitis). Furthermore, many other organs or organ systems may be affected. Case Report: This work describes a case of an immune thrombocytopenia that developed or rather became clinically significant shortly after initiation of a systemic therapy with first nivolumab and later pembrolizumab given due to metastatic melanoma. Platelet counts before this systemic therapy were slightly decreased with values around 110/nl (normal value 140-400/nl). Thrombocytopenia developed or became apparent rapidly within 10 days after the first intravenous application of nivolumab and worsened after changeover to pembrolizumab. Therapy had to be stopped due to disease progression and steady aggravation of thrombocytopenia. Immune hematology assays could prove an autoimmune mediated genesis of thrombocytopenia. Conclusion: Checkpoint inhibitors may induce a multiplicity of mostly autoimmune-mediated side effects. In contrast to chemotherapy-induced cytopenia that results from bone marrow toxicity, thrombocytopenia in melanoma patients treated with checkpoint inhibiting substances seems to result from autoimmune-mediated side effects in the majority of the cases. Thorough laboratory controls during these therapies are therefore required. In case of thrombocytopenia, immune hematology testing to diagnose or rule out immune thrombocytopenia is indispensable.

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“…This disease may be resulted from increased platelet destruction by humoral or cellular immune mechanisms, as well as improper platelet production in the bone marrow. (Aboud, Depré, & Salama, 2017).…”

Section: Results Of Comparative Test Of Il-17 Levels In the Itp And Nmentioning

confidence: 99%

Analysis of Interleukin-17 Levels in Patients with Thrombocytopenia

Christyawardani¹,

Arief²,

Bahrun³

2020

biomedika

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Thrombocytopenia or platelet deficiency is a condition, in which platelet level in the blood circulation is below normal, which is less than 150,000 cells/µl. Thrombocytopenia is classified into some conditions, including decreased platelet production, increased need for platelets, and other thrombocytopenia. The need for increased platelets can be subdivided into primary immune thrombocytopenia, secondary immune thrombocytopenia, non-primary ITP, and thrombocytopenia that are not immune-mediated. Several cytokines play a role in the process of thrombocytopenia, one of which is Interleukin-17 (IL-17) that will be further discussed in this study. A previous study reported that IL-17 production increased in ITP and cITP patients. The objective of this study was to analyze the IL-17 levels and figure out the differences in IL-17 levels in the serums of patients with primary ITP and secondary ITP. The samples were taken from Wahidin Sudirohusodo Hospital and the specimens were examined in the Research Unit Laboratory of the Faculty of Medicine, Universitas Hasanuddin/Hospital of Universitas Hasanuddin. The comparative test resulted in p-value = 0.005, where p <α = 0.05; and therefore, there was a significant difference between IL 17 levels in ITP and non-primary ITP.

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Is Autoimmune Thrombocytopenia Itself the Primary Disease in the Presence of Second Diseases Data from a Long-Term Observation

Cited by 9 publications

References 42 publications

Efficacy and tolerability of old and new drugs used in the treatment of immune thrombocytopenia: Results from a long-term observation in clinical practice

Efficacy and tolerability of old and new drugs used in the treatment of immune thrombocytopenia: Results from a long-term observation in clinical practice

A Case of Immune Thrombocytopenia as a Rare Side Effect of an Immunotherapy with PD1-Blocking Agents for Metastatic Melanoma

Analysis of Interleukin-17 Levels in Patients with Thrombocytopenia

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