Pathogenesis-oriented Approaches for the Management of Corticosteroid-resistant or Relapsedprimary Immune Thrombocytopenia

Overview

Journal Open Med (Wars)

Specialty General Medicine

Date 2017 Mar 30

PMID 28352775

Authors

Xin-Guang Liu

Ming Hou

Affiliations

Soon will be listed here.

Abstract

Primary immune thrombocytopenia (ITP) is a complex autoimmune disorder in which the patient's immune system reacts with platelet autoantigens resulting in immune-mediated platelet destruction and/or suppression of platelet production. Corticosteroids can induce sustained remission rates in 50% to 75% of patients with active ITP. For these patients who are unresponsive to glucocorticoids, or relapsed after an initial response, multiple second-line treatment modalities can be chosen. However, how to make an optimal therapeutic strategy for a specific patient still remains a major challenge. As the pathogenetic heterogeneity of the ITP is increasingly identified, pathogenesis-oriented approach might offer an opportunity to improve the outcome of corticosteroid-resistant or relapsed ITP.

References

Zeng Q, Zhu L, Tao L, Bao J, Yang M, Simpson E . Relative efficacy of steroid therapy in immune thrombocytopenia mediated by anti-platelet GPIIbIIIa versus GPIbα antibodies. Am J Hematol. 2011; 87(2):206-8. DOI: 10.1002/ajh.22211. View

Olsson B, Andersson P, Jernas M, Jacobsson S, Carlsson B, Carlsson L . T-cell-mediated cytotoxicity toward platelets in chronic idiopathic thrombocytopenic purpura. Nat Med. 2003; 9(9):1123-4. DOI: 10.1038/nm921. View

Cao J, Chen C, Li L, Ling-yu Z, Zhen-Yu L, Zhi-ling Y . Effects of high-dose dexamethasone on regulating interleukin-22 production and correcting Th1 and Th22 polarization in immune thrombocytopenia. J Clin Immunol. 2012; 32(3):523-9. DOI: 10.1007/s10875-012-9649-4. View

Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold D . Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2008; 113(11):2386-93. DOI: 10.1182/blood-2008-07-162503. View

Zhao C, Li X, Zhang F, Wang L, Peng J, Hou M . Increased cytotoxic T-lymphocyte-mediated cytotoxicity predominant in patients with idiopathic thrombocytopenic purpura without platelet autoantibodies. Haematologica. 2008; 93(9):1428-30. DOI: 10.3324/haematol.12889. View

Terrell D, Beebe L, Vesely S, Neas B, Segal J, George J . The incidence of immune thrombocytopenic purpura in children and adults: A critical review of published reports. Am J Hematol. 2010; 85(3):174-80. DOI: 10.1002/ajh.21616. View

Neunert C . Current management of immune thrombocytopenia. Hematology Am Soc Hematol Educ Program. 2013; 2013:276-82. DOI: 10.1182/asheducation-2013.1.276. View

Arnold D, Dentali F, Crowther M, Meyer R, Cook R, Sigouin C . Systematic review: efficacy and safety of rituximab for adults with idiopathic thrombocytopenic purpura. Ann Intern Med. 2007; 146(1):25-33. DOI: 10.7326/0003-4819-146-1-200701020-00006. View

Bussel J, Kuter D, George J, McMillan R, Aledort L, Conklin G . AMG 531, a thrombopoiesis-stimulating protein, for chronic ITP. N Engl J Med. 2006; 355(16):1672-81. DOI: 10.1056/NEJMoa054626. View

10.

Emmerich F, Bal G, Barakat A, Milz J, Muhle C, Martinez-Gamboa L . High-level serum B-cell activating factor and promoter polymorphisms in patients with idiopathic thrombocytopenic purpura. Br J Haematol. 2006; 136(2):309-14. DOI: 10.1111/j.1365-2141.2006.06431.x. View

11.

Zhang J, Ma D, Zhu X, Qu X, Ji C, Hou M . Elevated profile of Th17, Th1 and Tc1 cells in patients with immune thrombocytopenic purpura. Haematologica. 2009; 94(9):1326-9. PMC: 2738732. DOI: 10.3324/haematol.2009.007823. View

12.

Zhang F, Chu X, Wang L, Zhu Y, Li L, Ma D . Cell-mediated lysis of autologous platelets in chronic idiopathic thrombocytopenic purpura. Eur J Haematol. 2006; 76(5):427-31. DOI: 10.1111/j.1600-0609.2005.00622.x. View

13.

Guo C, Chu X, Shi Y, He W, Li L, Wang L . Correction of Th1-dominant cytokine profiles by high-dose dexamethasone in patients with chronic idiopathic thrombocytopenic purpura. J Clin Immunol. 2007; 27(6):557-62. DOI: 10.1007/s10875-007-9111-1. View

14.

Zhou H, Xu M, Qin P, Zhang H, Yuan C, Zhao H . A multicenter randomized open-label study of rituximab plus rhTPO vs rituximab in corticosteroid-resistant or relapsed ITP. Blood. 2015; 125(10):1541-7. PMC: 4351949. DOI: 10.1182/blood-2014-06-581868. View

15.

Bussel J, Cheng G, Saleh M, Psaila B, Kovaleva L, Meddeb B . Eltrombopag for the treatment of chronic idiopathic thrombocytopenic purpura. N Engl J Med. 2007; 357(22):2237-47. DOI: 10.1056/NEJMoa073275. View

16.

Gudbrandsdottir S, Birgens H, Frederiksen H, Jensen B, Jensen M, Kjeldsen L . Rituximab and dexamethasone vs dexamethasone monotherapy in newly diagnosed patients with primary immune thrombocytopenia. Blood. 2013; 121(11):1976-81. DOI: 10.1182/blood-2012-09-455691. View

17.

Liu B, Zhao H, Poon M, Han Z, Gu D, Xu M . Abnormality of CD4(+)CD25(+) regulatory T cells in idiopathic thrombocytopenic purpura. Eur J Haematol. 2007; 78(2):139-43. DOI: 10.1111/j.1600-0609.2006.00780.x. View

18.

Zhu X, Shi Y, Sun J, Shan N, Peng J, Guo C . High-dose dexamethasone inhibits BAFF expression in patients with immune thrombocytopenia. J Clin Immunol. 2009; 29(5):603-10. DOI: 10.1007/s10875-009-9303-y. View

19.

Peng J, Ma S, Liu J, Hou Y, Liu X, Niu T . Association of autoantibody specificity and response to intravenous immunoglobulin G therapy in immune thrombocytopenia: a multicenter cohort study. J Thromb Haemost. 2014; 12(4):497-504. DOI: 10.1111/jth.12524. View

20.

Yu H, Liu Y, Hou M . BAFF - an essential survival factor for B cells: Links to genesis of ITP and may be of therapeutic target. Med Hypotheses. 2007; 70(1):40-2. DOI: 10.1016/j.mehy.2007.05.005. View