Treatment of immune thrombocytopenic purpura associated with cytomegalovirus infection in a child with pre-B cell acute lymphoblastic leukaemia after central nervous system relapse

Martinez, Ashley R.; Paul, Megan; Kuo, Dennis John

doi:10.1136/bcr-2017-221947

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…In acute lymphoblastic leukemia (ALL), particularly T-ALL, several case reports described the association of AIHA, ITP, and PRCA, with variable triggers (ALL therapy, HSCT and infectious complications) and outcomes. Some Authors warned that, despite rarity, clinical suspicion should be high, since AICy may confound and delay the initial ALL diagnosis [ 17 , 22 , 27 ]. Finally, some reports described the onset of AICy (including AIHA, ITP, AIN and ES) before, concomitantly or after multiple myeloma (MM), mainly resolving after MM treatment [ 18 , 23 , 24 , 28 ].…”

Section: Autoimmune Complications In Lymphoid Neoplasmsmentioning

confidence: 99%

Autoimmune Complications in Hematologic Neoplasms

Barcellini

Giannotta

Fattizzo

2021

Cancers

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Autoimmune cytopenias (AICy) and autoimmune diseases (AID) can complicate both lymphoid and myeloid neoplasms, and often represent a diagnostic and therapeutic challenge. While autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP) are well known, other rarer AICy (autoimmune neutropenia, aplastic anemia, and pure red cell aplasia) and AID (systemic lupus erythematosus, rheumatoid arthritis, vasculitis, thyroiditis, and others) are poorly recognized. This review analyses the available literature of the last 30 years regarding the occurrence of AICy/AID in different onco-hematologic conditions. The latter include chronic lymphocytic leukemia (CLL), lymphomas, multiple myeloma, myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMML), myeloproliferative neoplasms, and acute leukemias. On the whole, AICy are observed in up to 10% of CLL and with higher frequencies in certain subtypes of non-Hodgkin lymphoma, whilst they occur in less than 1% of low-risk MDS and CMML. AID are described in up to 30% of myeloid and lymphoid patients, including immune-mediated hemostatic disorders (acquired hemophilia, thrombotic thrombocytopenic purpura, and anti-phospholipid syndrome) that may be severe and fatal. Additionally, AICy/AID are found in about 10% of patients receiving hematopoietic stem cell transplant or treatment with new checkpoint inhibitors. Besides the diagnostic difficulties, these AICy/AID may complicate the clinical management of already immunocompromised patients.

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Section: Autoimmune Complications In Lymphoid Neoplasmsmentioning

confidence: 99%

Autoimmune Complications in Hematologic Neoplasms

Barcellini

Giannotta

Fattizzo

2021

Cancers

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“…Symptomatic CMV infection was reported in 28 patients (19 boys, 9 girls; median age 8.5 years, range, 1‐15 years; Table 1). 10‐30 All but one patient suffered from ALL, and one patient had relapsed AML. The infection occurred in most of the patients ( n = 22) during maintenance therapy, and main symptoms were persisting fever not to be explained by other causes (19 patients), visual disturbances (10 patients), acute visual loss (one patient) or retinitis (two patients), pancytopenia (six patients) or hepatomegaly (eight patients).…”

Section: Resultsmentioning

confidence: 99%

Systemic viral infection in children receiving chemotherapy for acute leukemia

Buus-Gehrig

Bochennek

Hennies

et al. 2020

Pediatric Blood & Cancer

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Systemic viral diseases frequently occur in allogeneic hematopoietic stem cell transplantation, but data in children receiving chemotherapy for acute leukemia are scarce. We therefore collected and analyzed the published data on symptomatic infection from cytomegalovirus, herpes simplex virus, varicella zoster virus, parvovirus B19, or adenovirus in pediatric acute leukemia. Reports on 68 children were identified, of whom 16 patients have died from the infection. Further studies have to (1) evaluate the true incidence of these infections in pediatric acute leukemia, (2) their impact on outcome, and (3) whether a subpopulation of patients could benefit from screening and prophylactic strategies. K E Y W O R D S acute leukemia, adenovirus, child, cytomegalovirus, herpes simplex virus, parvovirus B19, systemic viral disease, varicella zoster virus We performed a MEDLINE (including MEDLINE In Process) search to identify relevant English-language articles indexed from January 1, 2000, up to December 31, 2019. The search included a combination of indexed terms and free text terms (child OR adolescent OR pediatr*); (cancer OR malignancy OR leukemia); (parvovirus OR b19)/(adenovirus)/(varicella or VZV)/(cytomegalovirus or CMV)/(herpes simplex virus or HSV). The hits were screened manually by two of the authors (CBG and TL). Only case reports and case series about systemic infections or studies on the prevalence of viremia with CMV, HSV, VZV, PVB19, and ADV, respectively, occurring in children

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“…Rituximab can cause disorders, such as arrhythmias or hypotension (7). Martinez et al (8) have stated that the efficacy of rituximab in combination with cyclophosphamide in the treatment of patients with refractory ITP is superior to traditional single-agent therapy. However, studies on the efficacy and clinical significance of rituximab in combination with cyclophosphamide in the treatment of refractory ITP patients are relatively rare.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic effects of rituximab combined with cyclophosphamide on refractory idiopathic thrombocytopenic purpura

Wang

Sun

et al. 2019

Exp Ther Med

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Therapeutic effects of rituximab combined with cyclophosphamide on refractory idiopathic thrombocytopenic purpura (ITP) were investigated. We retrospectively analyzed 249 patients with refractory ITP who were admitted to Qingdao Hiser Medical Group between March 2013 and March 2017. Curative effects of patients treated with rituximab, cyclophosphamide, and combination therapy were observed and the changes of platelet count, PA IgG, and lymphocyte CD20 before and after treatment, as well as the incidence of adverse reactions after treatment, were compared. There was no significant difference in the expression of lymphocyte CD20, PA IgG and platelet count among the three groups of refractory ITP patients before treatment (P>0.05). After treatment, the expression levels of CD20 and PA IgG in lymphocytes were significantly downregulated, and platelet counts significantly increased in the three groups (P<0.05). After treatment, CD20 and PA IgG levels in combined therapy group were significantly lower, and platelet count was significantly higher, than those in the rituximab and cyclophosphamide groups (P<0.05). Also, after rituximab treatment, the expression levels of CD20 and PA IgG in lymphocytes were significantly lower than those in cyclophosphamide group (P<0.05), and platelet count was higher than that in cyclophosphamide group (P<0.05). After treatment, the total effective rate in combined therapy group was higher than that in the rituximab and cyclophosphamide group (P<0.05). Total effective rate of rituximab group was significantly higher than that of cyclophosphamide group (P<0.05). The incidence of adverse reactions in combined therapy group was 14.29% (12/84), which was significantly lower than that in cyclophosphamide group (40.70%, 35/86, P<0.05) and rituximab group (29.11%, 23/79, P<0.05). The application of rituximab combined with cyclophosphamide in the treatment of refractory ITP can improve patients clinical symptoms. The efficacy of this technique is promising with no serious adverse reactions. This technique should be popularized in clinical practice.

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Treatment of immune thrombocytopenic purpura associated with cytomegalovirus infection in a child with pre-B cell acute lymphoblastic leukaemia after central nervous system relapse

Cited by 4 publications

References 7 publications

Autoimmune Complications in Hematologic Neoplasms

Autoimmune Complications in Hematologic Neoplasms

Systemic viral infection in children receiving chemotherapy for acute leukemia

Therapeutic effects of rituximab combined with cyclophosphamide on refractory idiopathic thrombocytopenic purpura

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