scholarly journals Ibrutinib effect in acquired von Willebrand syndrome secondary to Waldenström macroglobulinemia

2021 ◽  
Vol 12 ◽  
pp. 204062072110393
Author(s):  
María Poza ◽  
Rodrigo Íñiguez ◽  
Irene Zamanillo ◽  
Sara Redondo ◽  
Rafael Alonso ◽  
...  
Keyword(s):  
Von Willebrand Factor ◽  
Kinase Inhibitor ◽  
Receptor Expression ◽  
Acquired Von Willebrand Syndrome ◽  
Waldenström Macroglobulinemia ◽  
Risk Of Bleeding ◽  
Waldenstrom Macroglobulinemia ◽  
Bruton Tyrosine Kinase ◽  
Von Willebrand ◽  
Willebrand Factor

The pathological increase of clonal IgM in Waldenström macroglobulinemia can be associated with acquired von Willebrand syndrome and can be a major risk of bleeding symptoms in this subgroup of patients with Waldenström macroglobulinemia. The Bruton tyrosine kinase inhibitor ibrutinib is one of the approved treatments for symptomatic Waldenström macroglobulinemia. However, some controversy exists regarding the use of ibrutinib in these patients with high risk of bleeding because of its antiaggregant effect that could increase the risk of bleeding. Here, we present the case of a patient with Waldenström macroglobulinemia with associated acquired von Willebrand syndrome and progressively significant bleeding symptoms, who experienced a rapid increase in von Willebrand factor with ibrutinib treatment, despite only reaching a partial response in IgM levels similar to those reached with other previous treatments. We suggest that the control over the monoclonal protein is not the only mechanism that explains the good response, improvement in the bleeding symptoms and von Willebrand factor levels. This fact could be explained by the reduced glycoprotein Ib receptor expression induced by ibrutinib and the consequent von Willebrand factor increase in peripheral blood.

scholarly journals Clinical and prognostic implications of low or high level of von Willebrand factor in patients with Waldenström macroglobulinemia

Blood ◽  
2012 ◽  
Vol 120 (16) ◽  
pp. 3214-3221 ◽  
Author(s):  
Benedicte Hivert ◽  
Claudine Caron ◽  
Stephanie Petit ◽  
Cecile Charpy ◽  
Corinne Fankam-Siaka ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Mast Cells ◽  
Von Willebrand Factor ◽  
Immunoglobulin M ◽  
Viscosity Reduction ◽  
Acquired Von Willebrand Syndrome ◽  
Waldenström Macroglobulinemia ◽  
Waldenstrom Macroglobulinemia ◽  
Von Willebrand ◽  
Willebrand Factor

AbstractAcquired von Willebrand syndrome is described in patients with Waldenström macroglobulinemia (WM). Assessment of ristocetin cofactor activity (VWF:RCo) and von Willebrand factor (VWF) antigen (VWF:Ag) in 72 consecutive patients with WM showed a negative relation between VWF levels < 130 U/dL and both monoclonal immunoglobulin M concentration (mIgMC) and viscosity. Ten patients with VWF:RCo < 50 U/dL (< 40 for patients with blood group O) fulfilled the acquired von Willebrand syndrome criteria. They had higher mIgMC and viscosity. Reduction in mIgMC was associated with increase in VWF levels. The low VWF:RCo/VWF:Ag ratio suggested that high viscosity might be associated with increased shear force and cleavage of multimers. Surprisingly, 43 patients (59%) presented with high VWF:Ag (> 110 U/dL). They had higher bone marrow microvessel density and vascular endothelial growth factor expression on bone marrow mast cells. Five-year survival rates of patients with VWF:Ag < 110, between 110 and 250, and more than 250 U/dL were 96%, 71%, and 44%, respectively (P < .0001). High VWF:Ag was also a significant adverse prognostic factor for survival after first-line therapy (P < .0001), independently of the international scoring system. These results support systematic assessment of VWF in patients with WM. The adverse prognostic value of high VWF levels raises issues on interactions between lymphoplasmacytic cells, mast cells, and endothelial cells in WM.

Bing-Neel syndrome: A case reports

2020 ◽  
pp. 107815522098342
Author(s):  
Sinan Demircioğlu ◽  
Pembe Oltulu ◽  
Ganime D Emlik ◽  
Atakan Tekinalp ◽  
Özcan Çeneli
Keyword(s):  
Kinase Inhibitor ◽  
Case Reports ◽  
Rare Complication ◽  
Brain Biopsy ◽  
High Dose ◽  
Waldenström Macroglobulinemia ◽  
Dose Methotrexate ◽  
Waldenstrom Macroglobulinemia ◽  
Bruton Tyrosine Kinase ◽  
Methotrexate Treatment

Introduction Bing-Neel syndrome (BNS) is a rare complication of of Waldenström macroglobulinemia (WM) identified by involvement of central nervous system (CNS) lymphoplasmacytic cells. Case report We present a patient who was diagnosed with Bing-Neel syndrome four years after the diagnosis of Waldenström macroglobulinemia. Management & outcome The patient was admitted with neurological symptoms. There were lesions associated with WM involvement on brain imaging. The diagnosis was made by brain biopsy. High dose methotrexate treatment was given. Discussion CNS infiltrating agents such as fludarabine, methotrexate and cytarabine are often used in BNS treatment. Ibrutinib, which is a new bruton tyrosine kinase inhibitor, has recently started to be used in BNS treatment, as it has been shown to be effective and penetrate the CNS.

scholarly journals Clinical Significance of Inhibitors in Acquired von Willebrand Syndrome

Blood ◽  
1998 ◽  
Vol 91 (10) ◽  
pp. 3623-3629 ◽  
Author(s):  
Hiroshi Mohri ◽  
Shigeki Motomura ◽  
Heiwa Kanamori ◽  
Michio Matsuzaki ◽  
Shin-ichiro Watanabe ◽  
...  
Keyword(s):  
Von Willebrand Factor ◽  
Immunoglobulin Therapy ◽  
High Dose ◽  
Severe Bleeding ◽  
Bleeding Tendency ◽  
Intravenous Immunoglobulin Therapy ◽  
Acquired Von Willebrand Syndrome ◽  
Underlying Diseases ◽  
Von Willebrand ◽  
Willebrand Factor

Abstract Of 260 patients enrolled, 25 patients (9.6%) were associated with acquired von Willebrand syndrome (AvWS). We studied 25 patients with AvWS, retrospectively. AvWS was diagnosed by reduced levels of von Willebrand factor (vWF) (decrease of von Willebrand factor antigen [vWF:Ag] and von Willebrand ristocetin cofactor [vWF:RCoF]), a decrease of ristocetin-induced platelet agglutination (RIPA), sometimes decreased high-molecular-weight multimers, and prolonged bleeding time with neither prior nor family histories of bleeding problems and the evidence of normal vWF:RCoF in their families. The inhibitor of vWF was determined by mixing patient plasma with pooled normal plasma. Eight patients in this study had the inhibitors to vWF that were of the IgG class; the subclasses were IgG1 (7 cases) and IgG2 (1 case). Multimeric analysis of vWF showed selective loss of large multimers in most patients with AvWS similar to that of congenital type-2 von Willebrand disease (vWD). All inhibitors blocked ristocetin-mediated vWF binding to platelets. Five out of 6 IgGs evaluated here recognized the 39/34-kD fragment (residues 480/481-718) and Fragment III (residues 1-1365) that implied binding domain of glycoprotein Ib (GPIb), whereas 1 recognized Fragment I (residues 911-1365). A close relationship was found between the presence of the inhibitor and bleeding tendency. Of the 7 patients with inhibitors, 6 patients (86%) had a bleeding tendency, as well as 1 of the 15 patients without inhibitors (6%). The efficacy of treatment of underlying diseases and/or therapy with deamino D-arginine vasopressin (DDAVP) for the treatment of AvWS also depends on the presence of an inhibitor. Four of 8 patients with inhibitors (50%) had poor response to treatment of the underlying disease and/or therapy with DDAVP, as well as 1 of the 16 patients without inhibitors (6%). These results indicate that patients with AvWS developing inhibitors to vWF are likely to have bleeding problems and might be resistant to treatment of underlying diseases and/or therapy with DDAVP for bleeding to AvWS. We also showed evidence that intravenous immunoglobulin therapy (0.3 g/kg, 3 days) was effective to correct a hemostatic defect and manage severe bleeding in a patient with AvWS developing inhibitors. We might consider an additional treatment including expensive high-dose immunoglobulin therapy when uncontrollable bleeding is continued after the treatment of the underlying diseases and/or therapy with DDAVP.

Shear-induced interaction of platelets with von Willebrand factor results in glycoprotein Ibα shedding

2009 ◽  
Vol 297 (6) ◽  
pp. H2128-H2135 ◽  
Author(s):  
Hong Cheng ◽  
Rong Yan ◽  
Suping Li ◽  
Yanhong Yuan ◽  
Jun Liu ◽  
...  
Keyword(s):  
Von Willebrand Factor ◽  
Kinase Inhibitor ◽  
Plaque Rupture ◽  
Thrombus Formation ◽  
Small Mass ◽  
Ectodomain Shedding ◽  
Glass Capillary ◽  
Time Duration ◽  
Von Willebrand ◽  
Willebrand Factor

Shear-induced platelet adhesion through the interaction of glycoprotein (GP) Ibα with von Willebrand factor (VWF) exposed at the injured vessel wall or atherosclerotic plaque rupture is a prerequisite for the physiological hemostatic process or pathological thrombus formation in stenosed arteries. Here we show that shear-induced interaction of platelets with immobilized VWF results in GPIbα ectodomain shedding. Washed platelets were exposed to VWF-coated glass capillary or cone-and-plate viscometer at different shear rates, and GPIbα ectodomain was shed from platelets, while a small mass of GPIbα COOH-terminal peptide, ∼17 kDa, was increased correspondingly. The extent of GPIbα shedding was enhanced with the concentration of immobilized VWF and the time duration of constant shear stress, whereas it was obviously reduced with the decreased number of adherent platelets. Pretreatment of platelets with membrane-permeable calpain inhibitors and metalloproteinase inhibitor abolished shear-induced GPIbα shedding. Furthermore, GPIbα shedding was obviously diminished by anti-integrin-αIIbβ3monoclonal antibody SZ21, phosphatidylinositol 3-kinase inhibitor wortmannin, and cell-permeable calcium chelator 1,2-bis( o-aminophenoxy)ethane- N, N, N′, N′-tetraacetic acid. These results indicate that shear-induced platelet-VWF interaction results in calpain and metalloproteinase-dependent GPIbα ectodomain shedding. These findings not only have a physiological implication in understanding the presence of glycocalicin in normal circulation, but also suggest a novel mechanism for the negative regulation of platelet function and the limitation of platelet thrombus infinite formation under pathophysiological flow conditions.

Acquired von willebrand syndrome due to an inhibitor specific for von willebrand factor antigens

1986 ◽  
Vol 21 (3) ◽  
pp. 305-314 ◽  
Author(s):  
John Lazarchick ◽  
Alexandros A. Pappas ◽  
Joette Kizer ◽  
Sam A. Hall
Keyword(s):  
Von Willebrand Factor ◽  
Acquired Von Willebrand Syndrome ◽  
Von Willebrand ◽  
Willebrand Factor

Therapeutic Algorithm for Patients with Acquired Von Willebrand Syndrome and Monoclonal Gammopathy.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4445-4445
Author(s):  
Peter Staritz ◽  
Manuela Krause ◽  
Rainer Zimmermann ◽  
Angela Huth-Kuehne
Keyword(s):  
Von Willebrand Factor ◽  
Half Life ◽  
Major Surgery ◽  
Ivig Treatment ◽  
First Line ◽  
Acquired Von Willebrand Syndrome ◽  
Acute Bleeding ◽  
Therapeutic Algorithm ◽  
Von Willebrand ◽  
Willebrand Factor

Abstract Abstract 4445 In contrast to congenital von Willebrand Syndrome therapy of acute bleeding in acquired von Willebrand Syndrome (AWS) with von Willebrand factor containing concentrates (F VIII/vWF) is often ineffective. In patients with IgG monoclonal antibodies therapy with intravenous immunoglobulins (IVIG) is reported to be effective whereas patients with IgM antibodies seem not to respond to IVIG. Over the last years we diagnosed and treated several patients with AWS either prior to surgery or due to acute bleeding. About half of the patients responded adequately to IVIG as reported in the literature. One patient with no response to IVIG 4 days after the last dose received DDAVP with a significant increase in von Willebrand factor-antigen and ristocetin cofactor and normalized half life. Dental surgery could be performed without any bleeding complications under daily infusions of DDAVP. Another patient with partial response to IVIG and contraindications to DDAVP received F VIII/vWF prior to dental extraction. In contrast to former recoveries with a shortened half life of the infused concentrate (about 2 hours), half life of vWF was significantly prolonged following prior IVIG treatment. Another patient responded sufficiently to single therapy with F VIII/vWF. A further patient with suspected diagnosis of moderate hemophilia A had received DDAVP for severe epistaxis with good response and sufficient half lifes. He was transferred to our centre and we diagnosed AVW with IgM antibodies. We performed another recovery and half life with DDAVP with adequate response. According to our experience we propose the following therapeutic algorithm: A recovery with DDAVP should be performed first line if treatment is not contraindicated. In case of insufficient half lifes and/or intended major surgery, a recovery and half life with F VIII/vWF concentrate should follow. In case of significantly reduced half life of wWF an attempt with IVIG is necessary. If response to IVIG is not adequate further treatment with DDAVP or F VIII/vWF is indicated. As treatment with IVIG is not predictable in all patients with IgG antibodies and is very costly a therapeutic attempt with DDAVP in the first line and F VIII/vWF second line is worthwhile. In major surgery requiring prolonged replacement therapy, IVIG treatment, if effective, is less costly than treatment with FVIII/vWF. Disclosures: No relevant conflicts of interest to declare.

Singularities of haemorrhagic syndrome in children with native and acquired deficiencies of von Willebrand factor

2013 ◽  
Vol 4 (1) ◽  
pp. 78-85
Author(s):  
Kseniya Ivanovna Pshenichnaya ◽  
Yegor Viktorovich Lyugayev ◽  
Olga Georgiyevna Golovina
Keyword(s):  
Clinical Manifestation ◽  
Von Willebrand Factor ◽  
Clinical Studies ◽  
Clinical Manifestations ◽  
Underlying Disease ◽  
Von Willebrand Disease ◽  
Acquired Von Willebrand Syndrome ◽  
Different Types ◽  
Von Willebrand ◽  
Willebrand Factor

Deficiencies of content in blood and activity of von Willebrand factor can be inborn or acquired with diseases of different nature. Acquired deficiencies of von Willebrand factor or acquired von Willebrand syndrome in children have been described in several clinical studies. This research paper contains data on clinical manifestation and dynamics of haemorrhagic syndrome in 30 children between 13 months and 18 years of age with acquired von Willebrand factor, suffering from different types of pathology. Similarly, clinical manifestations and dynamics of angiostaxis have been studied in 33 children with von Willebrand disease. It has been determined that clinical manifestations of microcirculatory angiostaxis are the same for children from both groups; however, children with acquired von Willebrand syndrome showed dominating limited numbers of haemorrhagical symptoms that were shorter in duration and less intense. Besides, hematomic component of haemorrhagic syndrome was absent. Eventually, accompanied by positive dynamic of the underlying disease, relapses of haemorrhagic syndrome cease, which does not happen in case of the patients with von Willebrand disease.

scholarly journals Clinical Significance of Inhibitors in Acquired von Willebrand Syndrome

Blood ◽  
1998 ◽  
Vol 91 (10) ◽  
pp. 3623-3629
Author(s):  
Hiroshi Mohri ◽  
Shigeki Motomura ◽  
Heiwa Kanamori ◽  
Michio Matsuzaki ◽  
Shin-ichiro Watanabe ◽  
...  
Keyword(s):  
Von Willebrand Factor ◽  
Immunoglobulin Therapy ◽  
High Dose ◽  
Severe Bleeding ◽  
Bleeding Tendency ◽  
Intravenous Immunoglobulin Therapy ◽  
Acquired Von Willebrand Syndrome ◽  
Underlying Diseases ◽  
Von Willebrand ◽  
Willebrand Factor

Of 260 patients enrolled, 25 patients (9.6%) were associated with acquired von Willebrand syndrome (AvWS). We studied 25 patients with AvWS, retrospectively. AvWS was diagnosed by reduced levels of von Willebrand factor (vWF) (decrease of von Willebrand factor antigen [vWF:Ag] and von Willebrand ristocetin cofactor [vWF:RCoF]), a decrease of ristocetin-induced platelet agglutination (RIPA), sometimes decreased high-molecular-weight multimers, and prolonged bleeding time with neither prior nor family histories of bleeding problems and the evidence of normal vWF:RCoF in their families. The inhibitor of vWF was determined by mixing patient plasma with pooled normal plasma. Eight patients in this study had the inhibitors to vWF that were of the IgG class; the subclasses were IgG1 (7 cases) and IgG2 (1 case). Multimeric analysis of vWF showed selective loss of large multimers in most patients with AvWS similar to that of congenital type-2 von Willebrand disease (vWD). All inhibitors blocked ristocetin-mediated vWF binding to platelets. Five out of 6 IgGs evaluated here recognized the 39/34-kD fragment (residues 480/481-718) and Fragment III (residues 1-1365) that implied binding domain of glycoprotein Ib (GPIb), whereas 1 recognized Fragment I (residues 911-1365). A close relationship was found between the presence of the inhibitor and bleeding tendency. Of the 7 patients with inhibitors, 6 patients (86%) had a bleeding tendency, as well as 1 of the 15 patients without inhibitors (6%). The efficacy of treatment of underlying diseases and/or therapy with deamino D-arginine vasopressin (DDAVP) for the treatment of AvWS also depends on the presence of an inhibitor. Four of 8 patients with inhibitors (50%) had poor response to treatment of the underlying disease and/or therapy with DDAVP, as well as 1 of the 16 patients without inhibitors (6%). These results indicate that patients with AvWS developing inhibitors to vWF are likely to have bleeding problems and might be resistant to treatment of underlying diseases and/or therapy with DDAVP for bleeding to AvWS. We also showed evidence that intravenous immunoglobulin therapy (0.3 g/kg, 3 days) was effective to correct a hemostatic defect and manage severe bleeding in a patient with AvWS developing inhibitors. We might consider an additional treatment including expensive high-dose immunoglobulin therapy when uncontrollable bleeding is continued after the treatment of the underlying diseases and/or therapy with DDAVP.

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