Successful treatment of steroid-refractory immune thrombocytopenia with alemtuzumab
نویسندگان
چکیده
Fig. 1. Platelet count after alemtuzumab treatment. Successful treatment of steroid-refractory immune thrombocytopenia with alemtuzumab TO THE EDITOR: Immune thrombocytopenia (ITP) is an immune-mediated disease characterized by an isolated decrease in platelet count. There are multiple mechanisms underlying this disease, including autoantibodies against platelet membrane proteins and impaired platelet production [1]. In children, ITP is usually acute and the children have a spontaneous recovery, whereas in adults, ITP is chronic and irreversible. First-line therapy for ITP is cortico-steroids, which have response rates of 50%–90%; however, a durable response is observed in only 10–30% of patients. For steroid-refractory ITP, there are several treatments, such as splenectomy, danazol, azathioprine, cyclophosphamide, cyclosporine, rituximab, and thrombopoietin (TPO) receptor agonists [2]. Splenectomy induces a durable complete response in approximately 70% of patients with steroid-refractory ITP. However, it is associated with operative risks and post-operative complications such as encapsulated bacterial infections [3]. Rituximab has a good response rate of approximately 60% and a complete response rate of approximately 40%, though the durability over 5 years is only 15–20% [4]. Recently, the TPO receptor agonists, romiplostim and eltrombopag, demonstrated potent activity and had a response rate of more than 80%. However, However, their mechanism of action require relatively long maintenance period [5]. Other third-line therapies demonstrate minimal efficacy and their response duration is often short. Alemtuzumab, an anti-CD52 humanized monoclonal an-tibody, has shown strong durable immune suppression and has been used for lymphoproliferative disorders and auto-immune diseases such as multiple sclerosis. One study reported the safety and efficacy of alemtuzumab plus low-dose rituximab in patients with steroid-refractory ITP. The overall response rate was 100% and the median response duration was 46 weeks [6]. Another study reported about a patient with ITP and pure red cell aplasia who showed dramatic elevation of platelet count and hemoglobin levels after alem-tuzumab treatment [7]. Since there are few reports assessing the utility of alemtuzumab for treating ITP, this report documents the successful treatment of steroid-refractory ITP with alemtuzumab. We administered alemtuzumab to two patients (patient 1 and patient 2) who were diagnosed with ITP several years ago. Both patients were female, aged 48 and 50 years, respectively. Both had severe steroid-refractory thrombocy-topenia and did not respond to other treatments. Alemtuzu-mab was administered subcutaneously at a dose of 30 mg on days 1, 3, 5, 29, 31, and 33. We administrated 100 mg hydrocortisone intravenously and 650 mg acetaminophen orally 30 minutes …
منابع مشابه
Therapeutic Plasma Exchange in Pediatric Severe Immune Thrombocytopenia: A Case Report and Literature Review
Treatment of severe Immune Thrombocytopenic purpura (ITP) accompanied by life-threatening bleeding events is challenging and a combination of treatment measures should be undertaken to rapidly increase the platelet count. Herein, we report a case of severe ITP in a seven-year-old boy who suffered from massive bleeding which was totally unresponsive to conventional therapeutic interventions. Sin...
متن کاملLow-dose rituximab and alemtuzumab combination therapy for patients with steroid-refractory autoimmune cytopenias.
Treatment of autoimmune cytopenias remains unsatisfactory for patients refractory to first-line management. We evaluated the safety and efficacy of low-dose rituximab plus alemtuzumab in patients with steroid-refractory autoimmune hemolytic anemia and immune thrombocytopenic purpura. Nineteen of 21 included patients were assessable for response (11 with immune thrombocytopenic purpura, 8 with a...
متن کاملSuccessful Treatment of Refractory Autoimmune Hemolytic Anemia (AIHA) in a Child, Based on Iranian Traditional Medicine: A Case Report
Autoimmune hemolytic anemia (AIHA) is a heterogeneous and relatively unknown disease caused by premature immune destruction of red blood cells. While its occurrence is uncommon among children, it is sometimes severe and resistant to treatment. The warm-reactive type contains 70% to 80% of all cases, in which the first-line treatment is considered to be a steroid. Moreover, splenectomy, rituxima...
متن کاملRefractory idiopathic pure red cell aplasia complicated by immune thrombocytopenia successfully treated with subcutaneous alemtuzumab.
To the Editor: Only rare case reports of patients with pure red cell aplasia (PRCA) responding to alemtuzumab exist; however, most are secondary PRCA with only one being idiopathic [1]. We report a man with refractory idiopathic PRCA complicated by ITP, successfully treated with subcutaneous alemtuzumab. In Jan 2007, a 69-year-old man presented with idiopathic PRCA, refractory to treatments fro...
متن کاملSuccessful Treatment of Refractory Thrombotic Thrombocytopenic Purpura with Rituximab, a Monoclonal Antibody: a Case Report
Thrombotic thrombocytopenic purpura (TTP) is mostly attributed to the presence of an autoantibody against ADAMTS-13, a metalloprotease that degrades ultralarge von Willebrand protein multimers. Accumulation of vWF multimers and systemic platelet aggregation lead to microangiopathic thrombosis, hemolytic anemia, and end-organ ischemia. Most patients respond to therapeutic plasma exchange (TPE), ...
متن کامل