scholarly journals Efficacy of high-dose methylprednisolone as a first-line therapy in adult patients with idiopathic thrombocytopenic purpura

1998 ◽  
Vol 103 (4) ◽  
pp. 1061-1063 ◽  
Author(s):  
Önder Alpdogan ◽  
Tülin Budak-Alpdogan ◽  
Siret Ratip ◽  
Tülin Firatli-Tuglular ◽  
Serpil Tanriverdi ◽  
...  
Keyword(s):  
Idiopathic Thrombocytopenic Purpura ◽  
Adult Patients ◽  
High Dose ◽  
First Line ◽  
Thrombocytopenic Purpura ◽  
First Line Therapy ◽  
Line Therapy ◽  
High Dose Methylprednisolone

MECp, a Salvage Regimen with Drugs Not Employed as Frontline Therapy, Allowed to Obtain a High CR Rate and to Bring to Unrelated Allogeneic Transplantation a High Proportion of Adult Patients with Relapsed ALL.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4101-4101
Author(s):  
Erika Borlenghi ◽  
Elisa Cerqui ◽  
Chiara Cattaneo ◽  
Francesco Zuccalà ◽  
Piero Galbiati ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Adult Patients ◽  
Haematopoietic Stem Cell ◽  
High Dose ◽  
Cell Transplant ◽  
First Line ◽  
Salvage Regimen ◽  
Term Survival ◽  
First Line Therapy ◽  
Line Therapy

Abstract Abstract 4101 Background and aim The only curative option for adult patients with refractory or relapsed ALL is allogeneic haematopoietic stem cell transplant (allo-HSCT), which can offer a 28-34% long term survival in transplanted patients. However the actual feasibility of allo-HSCT is only 20-30% in unselected patients because of the low rate (30-50%) of complete remission (CR) achieved with salvage regimens (Tavernier, 2007- Thomas, 1999), the high rate of early relapse (Martino, 1999) and the difficulties in finding a suitable donor before progression (Davies, 1996). Hence, relapsed ALL can be actually cured in less than 10% of unselected adult patients. Using a second line treatment capable of obtaining a higher proportion of CR of longer duration may improve the dismal overall prognosis of patients. We report on the efficacy and toxicity profile of the combination of 6-metilprednisolone, mitoxantrone, etoposide and high-dose cytarabine (MECp), a salvage regimen containing cytostatic drugs to which patients had not been exposed during first line therapy, except for cytarabine at lower doses. Patients and Methods Between October 2000 and May 2009, 18 refractory/relapsed ALL patients were treated at our Institution with MECp regimen, consisting of a single course of etoposide 80mg/mq/die iv, cytarabine 1000mg/mq/die iv for 6 hours and mitoxantrone 6mg/mq/die iv 9 hours after cytarabine infusion for 6 days associated to metilprednisolone 50 mg/mq/die for 21 days, subsequently tapered to zero over one week. Three patients received an experimental sequential pulsed chemotherapy program in a multiinstitutional setting. At diagnosis, all patients had been treated according to the NILG-ALL 00/09 program (Bassan, Blood 2009). Four had been refractory to induction therapy and 14 had relapsed after a median of 12 months (range 3-43), 11 while on consolidation/maintenance, one after allo-HSCT, two after 3 and 12 months from the end of maintenance. There were 10 males and 8 females with a median age of 28 (range 17-64). ALL lineage was B in 9 cases (4 pro-B, 4 common, 1 pre B), T in 8 (5 pro-T, 3 cortical-TIII) and biphenotypic in 1. Molecular studies showed MLL/AF4 rearrangement in 3 and bcr/abl rearrangement in 3 cases, all before tyrosine-kinase inhibitors were available. Karyotypic abnormalities were present in 10 of 16 evaluable cases. Patients were treated in single/double bed rooms with reverse isolation. In 3 cases treatment duration was reduced to 4 days. Results CR was obtained in 13 of 18 patient (72,2%), independently of immunophenotype and time to relapse. CR rate was 100% in all ten patients with karyotypic abnormalities. Three patients (16%) died in aplasia during treatment, 2 of septic shock and 1 of unexplained shock. Two patients (T-ALL) were resistant. Recovery of neutrophils (>0,5×109/L) and platelets (>20×109/L) required a median of 22 days (range 17-37) and 28 days (range 21-45) from the start of therapy, respectively. Infections were documented in 9 of 18 (50%), being fatal in 2 (11%). Non-haematologic toxicity, mainly mucositis, was negligible. The median duration of CR was 5 months (range 2-5) which allowed 9 of 13 CR patients (69%) to undergo allo-HSCT (7 MUD, 1 HLA-identical sibling and 1 cord blood) after a median of 4 months (range 2-7) from CR. Reason for not being transplanted was failure of donor search in 4 patients who relapsed a median of 4 months. Causes of death included progressive disease in 7 patients, in 3 cases after HSCT, and transplant-related toxicity in 3 patients. The median survival of patients achieving CR was 13 months (range 7-33) and overall survival of the entire cohort was 8 months (range 1-33m). Conclusions With MECp, a combination of drugs not used during previous first-line therapy, a higher CR rate (72%) than commonly reported could be obtained, with acceptable toxicity. CR duration was long enough to allow 44,4% of patients to receive a non-family donor allo-HSCT, which is presently the best, yet still unsatisfactory, treatment option for adult patients with refractory/relapsed ALL. Disclosures: No relevant conflicts of interest to declare.

Triple Immunosuppressive Therapy in Patients with Chronic Resistant Immune Thrombocytopenic Purpura; a Case Series of 11 Patients.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2059-2059
Author(s):  
Howard H.W. Chan ◽  
Nancy M. Heddle ◽  
John G. Kelton
Keyword(s):  
Side Effects ◽  
Immunosuppressive Therapy ◽  
Case Series ◽  
Adult Patients ◽  
First Line ◽  
Thrombocytopenic Purpura ◽  
First Line Therapy ◽  
Line Therapy ◽  
Impaired Liver

Introduction: Immune thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by destruction of opsonized platelets. The first-line therapy for adult patients with chronic ITP includes steroid, IVIG and anti-D. Splenectomy is reserved for patients not responding to the first-line therapy. However, approximately 20–30% of patients are resistant or relapsed after splenectomy. In this subgroup of patients, more aggressive immunosuppressive therapy is indicated. Methods: This is a case series of patients with chronic resistant ITP receiving multiple immunosuppressive treatments in a tertiary medical referral center. The diagnosis of ITP was established by excluding other thrombocytopenic diseases. Adult patients with chronic resistant ITP presenting with life threatening thrombocytopenia were selected for a therapeutic trial of immunosuppressive therapy. The therapy included azathioprine 100–200 mg daily; cyclosporine 100–200 mg daily; and mycophenolate 1–2 gm daily (triple immunosuppressive therapy). All of these patients failed 1st line therapy; splenectomy; and other immunosuppressive treatments. Patients with uncontrolled hypertension; impaired liver functions; impaired renal functions; and those who have not completed family were excluded from triple immunosuppressive therapy. A response to the therapy was defined as persistent platelet count above 30 without other concurrent treatments. When patients responded to the triple immunosuppressive therapy, the doses of the medications were gradually tapered to minimize the long-term side effects. Results: Since July of 2000, 11 patients with chronic resistant ITP have received triple immunosuppressive therapy for a variable duration (table 1). Five out of these 11 patients (45.5%) achieved a response within 4 to 6 weeks after the initiation of the treatments. One of the five patients eventually had a break-through during the tapering of triple immunosuppressive therapy. This patient was stabilized by further doses of IVIG and prednisone. The treatments were well tolerated. The most common side effects were mildly elevated blood pressure; and mildly impaired liver function tests. None of the patients suffered from serious side effects that resulted in termination of the treatments. Conclusion: Combining low-dose azathioprine, cyclosporin and mycophenolate can induce long-term remission in patients with chronic ITP resistant to steroid, IVIG, splenectomy and other immunosuppressive agents. This combination regimen is safe and well-tolerated. In adult patients with chronic resistant ITP, the immune dysfunction may need multiple immune blockades. Summary of Treatments ID Rx Prior to Triple Rx Concurrent Rx with Triple Rx Mean (mg OD) Mean (mg OD) Mean (gm OD) Response Duration of Triple Rx Triple Rx:Triple Immunosuppressive Therapy; PRD:Prednisone; DAN:Danazol; AnD:Anti-D; SPN:Splenectomy; VCR:Vincristine; CTX:Cyclophosphamide; LUF:Luflunomide 1 PRD, IVIG, DAN, SPN PRD, IVIG 66.7 63.8 1 No 77 2 PRD, IVIG, DAN, SPN, VCR 75 25 0.8 No 20 3 PRD, AnD, SPN, CTX PRD (taper) 75 50 0.9 Yes 91 4 PRD, SPN, DAN, CTX, LUF 100 100 2 No 106 5 PRD, IVIG, SPN, DAN PRD, IVIG 144.2 236.1 1.9 No 217 6 PRD, IVIG, SPN, DAN, VCR IVIG 91.7 120.5 1.4 No 406 7 PRD, IVIG, DAN, SPN, VCR PRD (taper) 140.9 156.6 1.6 Yes 296 8 PRD, IVIG, SPN, DAN, VCR DAN (taper) 150 100 2 Yes 1351 9 PRD, DAN, SPN, AnD, CTX IVIG 100 150 2 No 130 10 PRD, IVIG, SPN, VCR, CTX PRD (taper) 85.6 121.1 1.4 Yes 1456 11 PRD, DAN, IVIG, SPN, AnD IVIG, PRD (taper) 125.6 225 1.9 Yes 875

Association between Platelet-Associated Immunoglobulin G Levels and Response to Corticosteroid Therapy in Patients with Newly Diagnosed Immune Thrombocytopenia

2020 ◽  
pp. 1-6
Author(s):  
Masuho Saburi ◽  
Masao Ogata ◽  
Yasuhiro Soga ◽  
Takako Satou ◽  
Kazuhito Itani ◽  
...  
Keyword(s):  
Corticosteroid Therapy ◽  
Immunoglobulin G ◽  
Immune Thrombocytopenia ◽  
High Dose ◽  
First Line ◽  
Laboratory Findings ◽  
Platelet Production ◽  
First Line Therapy ◽  
Line Therapy ◽  
Immature Platelet Fraction

<b><i>Objective:</i></b> Platelet-associated immunoglobulin G (PA-IgG) refers to IgG attached to the surface of platelets, while the immature platelet fraction (IPF) reflects the state of platelet production in bone marrow. Since PA-IgG and IPF are increased in patients with immune thrombocytopenia (ITP), reflecting amounts of platelet antibodies and compensatory platelet production, respectively, we hypothesized that these laboratory findings may provide useful markers for predicting treatment response in patients with ITP. We therefore retrospectively investigated associations between levels of these markers at diagnosis and response to first-line therapy in patients with ITP. <b><i>Methods:</i></b> Forty-three patients diagnosed with ITP at Oita Kouseiren Tsurumi Hospital between May 2010 and November 2018 were included. Patients were divided into 2 groups based on response to corticosteroid as first-line therapy. Laboratory findings were compared between responders and nonresponders. <b><i>Results:</i></b> Median PA-IgG was 285 ng/10<sup>7</sup> cells (range, 45.5–18,200 ng/10<sup>7</sup> cells), and median IPF was 15.5% (range, 5.4–62.1%). Median levels were higher than the respective upper limits of normal range (PA-IgG, 0–46 ng/10<sup>7</sup> cells; IPF, 1.1–9.5%). First-line therapy was performed using standard-dose prednisolone (0.5–1.0 mg/kg/day) in 32 patients and high-dose dexamethasone (40 mg/day, 4 days) or methylprednisolone (125–1,000 mg/day, 3–4 days) in 11 patients. Twenty-four patients (55.8%) responded to first-line therapy. In univariate analysis, type of corticosteroid (<i>p</i> = 0.17) tended to differ between groups but did not differ significantly, and no difference in IPF level was apparent between responders (15.35%; range, 5.4–41.5%) and nonresponders (16.7%; range, 6.3–62.1%; <i>p</i> = 0.15). PA-IgG was significantly higher among nonresponders (430 ng/10<sup>7</sup> cells; range, 101–18,200 ng/10<sup>7</sup> cells) than among responders (254.5 ng/10<sup>7</sup> cells; range, 45.5–470 ng/10<sup>7</sup> cells; <i>p</i> = 0.004). Multivariate analysis revealed PA-IgG was independently associated with response to first-line therapy (odds ratio, 1.000; 95% confidence interval, 1.000–1.010; <i>p</i> = 0.029). <b><i>Conclusion:</i></b> Our data suggested that PA-IgG at diagnosis could offer a useful predictor of response to first-line corticosteroid therapy for ITP.

High-dose, single-agent irinotecan as first-line therapy in the treatment of metastatic colorectal cancer

2002 ◽  
Vol 50 (5) ◽  
pp. 383-391 ◽  
Author(s):  
Ychou M. ◽  
Raoul J. ◽  
Desseigne F. ◽  
Borel C. ◽  
Caroli-Bosc F. ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Single Agent ◽  
High Dose ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy

scholarly journals A randomized phase 3 trial of auto vs. allo transplantation as part of first-line therapy in poor-risk peripheral T-NHL

Blood ◽  
2020 ◽  
Author(s):  
Norbert Schmitz ◽  
Lorenz H Truemper ◽  
Krimo Bouabdallah ◽  
Marita Ziepert ◽  
Mathieu Leclerc ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Lymphoma ◽  
Allogeneic Transplantation ◽  
T Cell Lymphoma ◽  
High Dose ◽  
First Line ◽  
High Dose Therapy ◽  
Peripheral T Cell Lymphoma ◽  
First Line Therapy ◽  
Line Therapy

Standard first-line therapy for younger patients with peripheral T-cell lymphoma consists of six courses of CHOP or CHOEP consolidated by high-dose therapy and autologous stem cell transplantation (AutoSCT). We hypothesized that consolidative allogeneic transplantation (AlloSCT) could improve outcome. 104 patients with nodal peripheral T-cell lymphoma except ALK+ ALCL, 18 to 60 years of age, all stages and IPI scores except stage 1 and aaIPI 0, were randomized to receive 4 x CHOEP and 1 x DHAP followed by high-dose therapy and AutoSCT or myeloablative conditioning and AlloSCT. The primary endpoint was event-free survival (EFS) at three years. After a median follow-up of 42 months, 3-year EFS of patients undergoing AlloSCT was 43% (95% confidence interval [CI]: 29%; 57%) as compared to 38% (95% CI: 25%; 52%) after AutoSCT. Overall survival at 3 years was 57% (95% CI: 43%; 71%) versus 70% (95% CI: 57%; 82%) after AlloSCT or AutoSCT, without significant differences between treatment arms. None of 21 responding patients proceeding to AlloSCT as opposed to 13 of 36 patients (36%) proceeding to AutoSCT relapsed. Eight of 26 patients (31%) and none of 41 patients died due to transplant-related toxicity after allogeneic and autologous transplantation, respectively. In younger patients with T-cell lymphoma standard chemotherapy consolidated by autologous or allogeneic transplantation results in comparable survival. The strong graft-versus-lymphoma effect after AlloSCT was counterbalanced by transplant-related mortality. CHO(E)P followed by AutoSCT remains the preferred treatment option for transplant-eligible patients. AlloSCT is the treatment of choice for relapsing patients also after AutoSCT.

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