Identification of a Subset of Aplastic Anemia Patients Highly Responsive to Danazol.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2817-2817
Author(s):  
Hirohito Yamazaki ◽  
Tatsuya Chuhjo ◽  
Chiharu Sugimori ◽  
Ken Ishiyama ◽  
Shinji Nakao
Keyword(s):  
Aplastic Anemia ◽  
Immunosuppressive Therapy ◽  
Anabolic Steroids ◽  
Univariate Analysis ◽  
Female Patients ◽  
Previously Treated ◽  
Male Patients ◽  
Danazol Therapy ◽  
Rate Of Response ◽  
Humara Assay

Abstract Treatment of patients refractory to immunosuppressive therapy is a major problem in the management of aplastic anemia (AA). Some patients who are ineligible for allogeneic stem cell transplantation have been successfully treated with anabolic steroids although little is known about the common characteristics of these patients. In order to characterize high responders to danazol, we retrospectively studied 44 AA (13 male and 31 female) patients who were treated with 300 mg of danazol daily for at least 3 months. All patients had been previously treated with ATG+CsA or CsA alone without appreciable effects before danazol therapy. Peripheral blood of these patients was examined for the presence of PNH-type cells and clonality in granulocytes using sensitive flow cytometry (Blood100: 3897, 2002) and the improved HUMARA assay (Blood102: 1211, 2003). 24 of 44 (55%) patients attained PR or CR according to the response criteria proposed by Camitta. All 3 lineage cells increased in the responders. The rate of response in female patients (21/31, 68%) was significantly higher than that (3/13, 23%) in male patients (P=0.0058). There was no difference in the response rate between older (>50 years) patients (75%) and younger (<50 years) patients (60%) in female patients, indicating that the effect of danazol is not affected by a female sex hormone. Increased PNH-type cells were detectable in 2 (8.3%) of 24 responders and in 6 (40%) of 15 non-responders. The HUMARA assay revealed presence of clonal granulocyte population in 13 (76%) of 17 responders and 2 (33%) of 6 non-responders, respectively. For a female patient without increased PNH type cells who has not responded to immunosuppressive therapy, the rate of response to danazol was 64%. Probability of 3-year survival in responders to danazol was 100% while that in non-responders to the therapy was 90%. Univariate analysis revealed that negativity for increased PNH-type cell and being female were significantly associated with good response to danazol. These findings indicate that danazol is a useful drug in the treatment of a subset of female AA patients characterized by refractoriness to conventional immunosuppressive therapy and absence of increased PNH-type cells. Given the high frequency of clonal hematopoiesis in responders to danazol, this anabolic steroid may stimulate expansion of a small number of stem cells that survived non-immune marrow insult.

scholarly journals Danazol therapy for aplastic anemia refractory to immunosuppressive therapy

2008 ◽  
Vol 83 (5) ◽  
pp. 387-389 ◽  
Author(s):  
Tatsuya Chuhjo ◽  
Hirohito Yamazaki ◽  
Mitsuhiro Omine ◽  
Shinji Nakao
Keyword(s):  
Aplastic Anemia ◽  
Immunosuppressive Therapy ◽  
Danazol Therapy

Side Effects Of Immunosuppressive Therapy(IST) Of Aplastic Anemia In Children

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2483-2483
Author(s):  
Malgorzata Salamonowicz ◽  
Katarzyna Pawelec ◽  
Michal Matysiak ◽  
Anna Panasiuk ◽  
Jerzy Kowalczyk ◽  
...  
Keyword(s):  
Side Effects ◽  
Aplastic Anemia ◽  
Immunosuppressive Therapy ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Unknown Origin ◽  
Infectious Complications ◽  
Gingival Hyperplasia ◽  
Pathophysiological Mechanism ◽  
Free Survival

Abstract Introduction Acquired aplastic anemia is very rare disease characterized by and pancytopenia and hypoplastic bone marrow. In 70% of cases the etiology is idiopathic but some cases can be caused by drugs, chemical substances and viruses. One of the main pathophysiological mechanism of aplastic anemia is immune-mediated destruction of hematopoietic cells. As a result of that the immunosuppressive therapy (IST) persists the treatment of choice in patients with severe acquired aplastic anemia (SAA), who don’t have matched sibling donor. Since few last years there is a discussion if it is still the best way of treatment. We wanted to show the side effects of IST during the therapy of SAA using the rabbit antithymocyte globulin(r-ATG) Methods The group of 55 children ( 32 boys, 23 girls) with SAA and vSAA (very severe aplastic anemia) treated with r-ATG , steroids, CSA, and/or GSF-CS was retrospectively analyzed. The median age of the children was 10 years (range 6mth-17,5 years). Response rate was assessed on days 84, 112,180, 360. Kaplan–Meier estimator, univariate analysis and multivariate Cox regression models were used to estimate the influence of side effects for PFS (progression free survival) and EFS( event free survival). Results Infectious complications (fever of unknown origin-FUO-26,92%, stomatitis -19,23% and sepsis -17,03% ) were the most common side effects of IST. The most common etiology were : E. coli, P. aureginosa, S. aureus, Kl. pneumonie, E. fecium, E. cloace. There was a significant association between EFS and infectious side effects (p=0,00093- log rank). Among side effects of r-ATG fever (30,30%) and dyspnoe (24,24%) were the most common.After CSA mainly gingival hyperplasia, hirsutysm and hypertension were observed. The most common hemorrhagic side effects of IST were skin petechiae. The other were central nervous system bleeding, gastrointestinal tract bleeding. There was significant correlation between the hemorrhagic side effects and PFS(p= 0,0144 log rank).After the G-CSF therapy muscular pains, and capillary leak syndrome, was observed but it didn’t influence survival. Among all patients 15 deaths was observed (27,27%)-5 early and 10 late deaths. Infections were the main causes of death. The relapse rate was 1,81%. The 2-year probability of not having relapse was 87,68%. Relapse free survival was 75,16% at 5 and 10 years. There was one transformation to paroxysmal nocturnal hemoglobinuria (PNH). There were no transformation to MDS or AML.Discussion. Infections are the most common side effects during the IST with r- ATG. Hemorrhagic side effects and infectious complications are very important factors which can affect the survival rate in children with SAA. Disclosures: Szczepanski: Octapharma AG: Investigator Other.

scholarly journals Reactivation of Hepatitis B Virus Infection in Aplastic Anemia Patients Receiving Immunosuppressive Therapy

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5107-5107
Author(s):  
Hua Yin ◽  
Suli Wang ◽  
Xingyu Lu ◽  
Wenyi Shen ◽  
Ruinan Lu ◽  
...  
Keyword(s):  
Aplastic Anemia ◽  
Antiviral Therapy ◽  
Immunosuppressive Therapy ◽  
Conflicts Of Interest ◽  
Univariate Analysis ◽  
Hbv Infection ◽  
High Rate ◽  
Hbv Reactivation ◽  
Antiviral Prophylaxis ◽  
Lamivudine Therapy

Abstract Objective: The aim of this study was to assess the risk of HBV reactivation in HBsAg-positive or negative, HBcAb-positive patients with aplastic anemia (AA) receiving immunosuppressive therapy. Methods: We analyzed clinical data of 60 AA patients with HBV infection out of 201 cases. Entecavir or lamivudine therapy was initiated if HBV reactivation was encountered, or used as antiviral prophylaxis regimen for HBsAg-positive patients. Result: Among 60 AA patients, 12 were chronically infected and 48 were previously exposed. There was no difference in clinical features in AA patients with or without HBV infection. The prevalence of non-severe AA (NSAA) progressed to severe AA (SAA) was similar in two groups (35.6% vs 42.7%, p=1.0). In NSAA group, the response rate to CsA, to ATG and CsA, and progression to SAA were similar in patients with or without HBV infection (35.7% vs 35.3%, p>0.05; 42.8% vs 58.8%, p= 1.0; 35.5% vs 42.7%, p= 0.414). In SAA group, patients with or without HBV infection responded to ATG and CsA therapy similarly (83.33% vs 59.0%, p = 0.252). HBV reactivation was occurred in all 5 HBsAg positive patients without any antiviral therapy, while no HBV reactivation happened in other 7 patients received antiviral therapy. Disease course (RR=1.012, p=0.036) and absolute reticulocyte count (RR=11.556, P=0.025) were the risk factors for HBV reactivation by univariate analysis. Logistic regression indicated that HBsAg positivity without preventive therapy was the only strong factor for HBV reactivation. Conclusion: Antiviral prophylaxis is recommended for HBsAg-positive patients with AA who will receive IST because of high rate of HBV reactivation. HBV infection has no influence on the clinic course of AA, and antiviral therapy does not affect the efficacy of IST. Disclosures No relevant conflicts of interest to declare.

BODY CELL MASS DURING LONG-TERM TREATMENT WITH CORTISONE AND ANABOLIC STEROIDS IN ASTHMATIC SUBJECTS

1967 ◽  
Vol 55 (2) ◽  
pp. 222-239 ◽  
Author(s):  
Björn Lindholm
Keyword(s):  
Anabolic Steroids ◽  
Cell Mass ◽  
Relative Increase ◽  
The Body ◽  
Body Cell Mass ◽  
Body Cell ◽  
Female Patients ◽  
Long Term Treatment ◽  
Male Patients ◽  
Normal Men

ABSTRACT Thirty-six patients (17 males and 19 females) with severe bronchial asthma were treated for more than two years with cortisone and norandrolone. The patients were followed by repeated estimations of the body cell mass (BCM) using total exchangeable potassium (Ke) as a parameter of cell mass. In ten of the female patients, determinations of total body water (TBW) were also performed at the end of anabolic treatment. BCM increased significantly in both male (3.3 kg) and female (4.5 kg) patients. The relative increase in BCM was more pronounced in the female (25%) than in the male patients (13%). After one year of anabolic therapy, no further increase in BCM was demonstrated in either sex. The male patients did not increase more than was seen in male patients on cortisone only and previously reported. The average body weight was unchanged during the study, indicating a decrease in body fat. In the female patients, the final relative body cell mass was higher than in normal women and similar to that of normal men. TBW also increased in proportion to Ke and at the end of treatment the quotient TBW/B.W. was not different from that of normal men. The regression of Ke on TBW was normal. The significance of these findings are discussed. During treatment, one woman developed radiological signs of osteoporosis and two males showed progression of bone atrophy, which was diagnosed before the study.

The Telomere Length In Peripheral Blood Lymphocytes Is a Useful Predictor of the Response to Immunosuppressive Therapy In Patients with Acquired Aplastic Anemia

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2042-2042
Author(s):  
Yoshiyuki Takahashi ◽  
Sayoko Doisaki ◽  
Nobuhiro Nishio ◽  
Hideki Muramatsu ◽  
Akira Shimada ◽  
...  
Keyword(s):  
Aplastic Anemia ◽  
Immunosuppressive Therapy ◽  
Telomere Length ◽  
Peripheral Blood ◽  
Univariate Analysis ◽  
Peripheral Blood Lymphocytes ◽  
Telomere Maintenance ◽  
Blood Lymphocytes ◽  
Diploid Cells ◽  
Telomere Signal

Abstract Abstract 2042 Introduction: The ability to predict the response to immunosuppressive therapy (IST) in patients with aplastic anemia (AA) will avoid unnecessary and possibly harmful treatment. To this end, several in vitro tests have been proposed as useful predictors of response in adult patients. However, we previously reported that the presence of either human leukocyte antigen (HLA)-DR15, a minor population of paroxysmal nocturnal hemoglobinuria (PNH)-type cells, or of autoantibodies to postmeiotic segregation increased 1 (PMS1) in children with AA, were not useful predictors of the response to IST, suggesting a different etiology of AA between adults and children (Yoshida, N et al Br J Haematol. 2008). Telomeres in peripheral blood cells from AA patients are shorter than those from normal individuals in 30% of patients. This shorter telomere length in AA patients is thought to result from genetic abnormalities in the genes related to telomere maintenance, stressed hematopoiesis due to immunological attack, and increased cell division. An NIH group and we reported that cryptic forms of dyskeratosis congenita (DC) are present in just under 5% of patients with AA who do not have physical abnormalities, but who harbour the gene mutation associated with telomere maintenance (Yamaguchi, H et al. N Engl J Med. 2005, Liang, J et al. Haematologica 2006). To identify such patients is important because those who have these mutations might respond poorly to IST. However, the presence of cryptic forms of DC does not explain the causes of short telomeres in the other patients. We hypothesized that patients with short telomeres may respond poorly to IST, and thus evaluated the relationship between telomere length in hematopoietic cells before IST and the response to IST in patients with AA. Patients and Methods: We enrolled 40 newly diagnosed children with AA (median age, 10 years; range, 1 to 16 years) who received IST. We obtained peripheral blood lymphocytes from the patients with AA at the time of diagnosis and prospectively measured the telomere length of lymphocytes prior to IST by flow-fluorescence in situ hybridization (flow-FISH) using Telomere PNA kits (Dako Cytomation, Glostrup, Denmark). After gating diploid cells based on propidium iodine staining, lymphocytes were isolated according to size and granularity. Relative telomere length (RTL) was calculated as the ratio between the telomere signal of each sample and the telomere signal of the control cell line. Because telomeres shorten with age, we obtained age-adjusted measurements for comparison from 71 normal age-matched individuals. Delta RTL of each patient with AA was calculated using the distance of the RTL from the line of age-adjusted normal telomere length. Results: Of the 40 patients, at diagnosis AA was very severe in 12, severe in 13, and non-severe in 15. All received IST with horse antithymocyte globulin (ATG) and cyclosporine. The causes of AA were idiopathic in 38 patients and hepatitis in 2. In total, 25 of the 40 patients (63%) responded to IST at 6 months after administration of ATG. Between the responder and non-responder groups, no significant differences in gender, age, etiology, disease severity or interval from diagnosis, and IST were observed. Univariate analysis for IST response did not find any significant differences in median WBC count, neutrophil count, Hb level, reticulocyte count, platelet count or minor PNH clone positivity between the groups. However, delta RTL was significantly lower in non-responders than in responders (p=0.035). Multivariate analysis for response to IST revealed that only delta RTL was significantly lower in non-responders than responders (p = 0.049). Conclusion: The telomere length in lymphocytes is promising not only to identify cryptic DC but also to predict the response to IST of patients with AA. A further larger analysis is warranted to evaluate the correlation between telomere length and the response to IST in AA patients. Disclosures: No relevant conflicts of interest to declare.

GAMBARAN ANGKA KEJADIAN STROKE AKIBAT HIPERTENSI DI INSTALASI REHABILITASI MEDIK BLU RSUP PROF. DR. R. D. KANDOU MANADO PERIODE JANUARI – DESEMBER 2011

e-CliniC ◽  
2013 ◽  
Vol 1 (2) ◽  
Author(s):  
Ariesta Zubiah Ramadhini ◽  
L. S. Angliadi ◽  
Engeline Angliadi
Keyword(s):  
Descriptive Study ◽  
Medical Rehabilitation ◽  
Stroke Patients ◽  
Female Patients ◽  
Male Patients

Abstract: Stroke may cause a serious problem that leads to a disability or even mortality. The purpose is to determine such an incidence caused by hypertension at the Installation of Medical Rehabilitation RSUP Prof. dr. R. D. Kandou Manado based on the characteristic of age, gender and occupation. This research was taken at the Installation of Medical Rehabilitation RSUP Prof. R. D. Kandou Manado by using retrospective descriptive study method as well as examining 228 new cases of stroke patients that correlated with conclusion criteria. The result showed 8,3% patients at ≤44th years old, 33,3% patients at 45th – 54th years old, 32% patients at 55th – 64th years old, 20,25% patients at 65th – 74th years old, 6,1% patients at 75th – 84th years old. 53,1% male patients, 46,9% female patients. 33,3% retirement, 18% farmers, 18% government officers, 5,3% private employees, 2,2% drivers, 0,9% teachers and, 3,1% housewives. Keywords: incidence, hypertension, stroke   Abstrak: Stroke dapat menimbulkan masalah besar karena menyebabkan kecacatan dan kematian. Tujuan, mengetahui gambaran angka kejadian stroke akibat hipertensi di Instalasi Rehabilitasi Medik RSUP Prof. Dr. R. D. Kandou Manado sesuai dengan karakteristik umur, jenis kelamin, dan jenis pekerjaan. Penelitian dilakukan di Instalasi Rehabilitasi Medik BLU RSUP Prof. dr. R. D. Kandou Manado, dilakukan secara retrospektif deskriptif dan didapatkan sampel sebanyak 228 data pasien kunjungan baru kasus stroke sesuai kriteria inklusi yang ditetapkan. Hasil penelitian, pasien stroke berumur ≤44 tahun 8,3%, berumur 45 – 54 tahun 33,3%, berumur 55 – 64 tahun 32%, berumur 65 – 74 tahun 20,25%, berumur 75 – 84 tahun 6,1%. Pasien stroke berjenis kelamin laki – laki 53,1%, perempuan 46,9%. Pasien stroke yang berstatus pekerjaan pensiunan 33,3%, petani 18%, PNS 18%, pegawai swasta 5,3%, supir 2,2%, guru 0,9%, IRT 3,1%. Kata Kunci: gambaran angka kejadian, hipertensi, stroke

scholarly journals Differences in Outcomes Between Anterior and Posterior Shoulder Instability After Arthroscopic Bankart Repair: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110064
Author(s):  
Matthew L. Vopat ◽  
Reed G. Coda ◽  
Nick E. Giusti ◽  
Jordan Baker ◽  
Armin Tarakemeh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Posterior Shoulder Instability ◽  
Anterior Instability ◽  
Posterior Instability ◽  
Female Patients ◽  
Posterior Shoulder ◽  
Male Patients ◽  
Postoperative Instability

Background: The glenohumeral joint is one of the most frequently dislocated joints in the body, particularly in young, active adults. Purpose: To conduct a systematic review and meta-analysis to evaluate and compare outcomes between anterior versus posterior shoulder instability. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed using the PubMed, Cochrane Library, and MEDLINE databases (from inception to September 2019) according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they were published in the English language, contained outcomes after anterior or posterior shoulder instability, had at least 1 year of follow-up, and included arthroscopic soft tissue labral repair of either anterior or posterior instability. Outcomes including return-to-sport (RTS) rate, postoperative instability rate, and pre- and postoperative American Shoulder and Elbow Surgeons (ASES) scores were recorded and analyzed. Results: Overall, 39 studies were included (2077 patients; 1716 male patients and 361 female patients). Patients with anterior instability had a mean age of 23.45 ± 5.40 years (range, 11-72 years), while patients with posterior instability had a mean age of 23.08 ± 8.41 years (range, 13-61 years). The percentage of male patients with anterior instability was significantly higher than that of female patients (odds ratio [OR], 1.36; 95% CI, 1.04-1.77; P = .021). Compared with patients with posterior instability, those with anterior instability were significantly more likely to RTS (OR, 2.31; 95% CI, 1.76-3.04; P < .001), and they were significantly more likely to have postoperative instability (OR, 1.53; 95% CI, 1.07-2.23; P = .018). Patients with anterior instability also had significantly higher ASES scores than those with posterior instability (difference in means, 6.74; 95% CI, 4.71-8.77; P < .001). There were no significant differences found in postoperative complications between the anterior group (11 complications; 1.8%) and the posterior group (3 complications; 1.6%) (OR, 1.12; 95% CI, 0.29-6.30; P = .999). Conclusion: Patients with anterior shoulder instability had higher RTS rates but were more likely to have postoperative instability compared with posterior instability patients. Overall, male patients were significantly more likely to have anterior shoulder instability, while female patients were significantly more likely to have posterior shoulder instability.

scholarly journals POS1189 THE IMPACT OF TELEMEDICINE AND COVID-19 ON A TERTIARY RHEUMATOLOGY SERVICE: A RETROSPECTIVE AUDIT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 876-877
Author(s):  
W. Zhu ◽  
T. De Silva ◽  
L. Eades ◽  
S. Morton ◽  
S. Ayoub ◽  
...  
Keyword(s):  
Immunosuppressive Therapy ◽  
Univariate Analysis ◽  
Diagnostic Delay ◽  
Cohort Differences ◽  
Phone Calls ◽  
Retrospective Audit ◽  
Common Diagnosis ◽  
Significant Difference ◽  
The Impact

Background:Telemedicine was widely utilised to complement face-to-face (F2F) care in 2020 during the COVID-19 pandemic, but the impact of this on patient care is poorly understood.Objectives:To investigate the impact of telemedicine during COVID-19 on outpatient rheumatology services.Methods:We retrospectively audited patient electronic medical records from rheumatology outpatient clinics in an urban tertiary rheumatology centre between April-May 2020 (telemedicine cohort) and April-May 2019 (comparator cohort). Differences in age, sex, primary diagnosis, medications, and proportion of new/review appointments were assessed using Mann-Whitney U and Chi-square tests. Univariate analysis was used to estimate associations between telemedicine usage and the ability to assign a diagnosis in patients without a prior rheumatological diagnosis, the frequency of changes to immunosuppression, subsequent F2F review, planned admissions or procedures, follow-up phone calls, and time to next appointment.Results:3,040 outpatient appointments were audited: 1,443 from 2019 and 1,597 from 2020. There was no statistically significant difference in the age, sex, proportion of new/review appointments, or frequency of immunosuppression use between the cohorts. Inflammatory arthritis (IA) was a more common diagnosis in the 2020 cohort (35.1% vs 31%, p=0.024). 96.7% (n=1,444) of patients seen in the 2020 cohort were reviewed via telemedicine. In patients without an existing rheumatological diagnosis, the odds of making a diagnosis at the appointment were significantly lower in 2020 (28.6% vs 57.4%; OR 0.30 [95% CI 0.16-0.53]; p<0.001). Clinicians were also less likely to change immunosuppressive therapy in 2020 (22.6% vs 27.4%; OR 0.78 [95% CI 0.65-0.92]; p=0.004). This was mostly driven by less de-escalation in therapy (10% vs 12.6%; OR 0.75 [95% CI 0.59-0.95]; p=0.019) as there was no statistically significant difference in the escalation or switching of immunosuppressive therapies. There was no significant difference in frequency of follow-up phone calls, however, patients seen in 2020 required earlier follow-up appointments (p<0.001). There was also no difference in unplanned rheumatological presentations but significantly fewer planned admissions and procedures in 2020 (1% vs 2.6%, p=0.002). Appointment non-attendance reduced in 2020 to 6.5% from 10.9% in 2019 (OR 0.57 [95% CI 0.44-0.74]; p<0.001), however the odds of discharging a patient from care were significantly lower in 2020 (3.9% vs 6%; OR 0.64 [95% CI 0.46-0.89]; p=0.008), although there was no significance when patients who failed to attend were excluded. Amongst patients seen via telemedicine in 2020, a subsequent F2F appointment was required in 9.4%. The predictors of needing a F2F review were being a new patient (OR 6.28 [95% CI 4.10-9.64]; p<0.001), not having a prior rheumatological diagnosis (OR 18.43 [95% CI: 2.35-144.63]; p=0.006), or having a diagnosis of IA (OR 2.85 [95% CI: 1.40-5.80]; p=0.004) or connective tissue disease (OR 3.22 [95% CI: 1.11-9.32]; p=0.031).Conclusion:Most patients in the 2020 cohort were seen via telemedicine. Telemedicine use during the COVID-19 pandemic was associated with reduced clinic non-attendance, but with diagnostic delay, reduced likelihood of changing existing immunosuppressive therapy, earlier requirement for review, and lower likelihood of discharge. While the effects of telemedicine cannot be differentiated from changes in practice related to other aspects of the pandemic, they suggest that telemedicine may have a negative impact on the timeliness of management of rheumatology patients.Disclosure of Interests:None declared.

scholarly journals Recombinant Human Thrombopoietin Treatment Promotes Hematopoiesis Recovery in Patients with Severe Aplastic Anemia Receiving Immunosuppressive Therapy

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Huaquan Wang ◽  
Qi’e Dong ◽  
Rong Fu ◽  
Wen Qu ◽  
Erbao Ruan ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Aplastic Anemia ◽  
Immunosuppressive Therapy ◽  
Severe Aplastic Anemia ◽  
Red Blood Cell Transfusion ◽  
Overall Survival Rate ◽  
Normal Range ◽  
Hematologic Response ◽  
Transfusion Independence ◽  
Recombinant Human Thrombopoietin

Objective. To assess the effectiveness of recombinant human thrombopoietin (rhTPO) in severe aplastic anemia (SAA) patients receiving immunosuppressive therapy (IST).Methods. Eighty-eight SAA patients receiving IST from January 2007 to December 2012 were included in this retrospective analysis. Of these, 40 subjects received rhTPO treatment (15000 U, subcutaneously, three times a week). rhTPO treatment was discontinued when the platelet count returned to normal range. Hematologic response, bone marrow megakaryocyte recovery, and time to transfusion independence were compared.Results. Hematologic response was achieved in 42.5%, 62.5%, and 67.5% of patients receiving rhTPO and 22.9%, 41.6%, and 47.9% of patients not receiving rhTPO at 3, 6, and 9 months after treatment, respectively (P= 0.0665,P= 0.0579, andP= 0.0847, resp.). Subjects receiving rhTPO presented an elevated number of megakaryocytes at 3, 6, and 9 months when compared with those without treatment (P= 0.025,P= 0.021, andP= 0.011, resp.). The time to platelet and red blood cell transfusion independence was shorter in patients who received rhTPO than in those without rhTPO treatment. Overall survival rate presented no differences between the two groups.Conclusion. rhTPO could improve hematologic response and promote bone marrow recovery in SAA patients receiving IST.

scholarly journals Clomiphene fails to revert hypogonadism in most male patients with conventionally treated nonfunctioning pituitary adenomas

2011 ◽  
Vol 55 (4) ◽  
pp. 266-271 ◽  
Author(s):  
Rogerio Silicani Ribeiro ◽  
Julio Abucham
Keyword(s):  
Pituitary Adenomas ◽  
Erectile Function ◽  
Prospective Trial ◽  
Open Label ◽  
Dopaminergic Therapy ◽  
Testosterone Levels ◽  
Nonfunctioning Pituitary Adenomas ◽  
Before And After ◽  
Previously Treated ◽  
Male Patients

OBJETIVE: To evaluate the effect of clomiphene in men with hypogonadism and conventionally treated nonfunctioning pituitary adenomas (NFPA). PATIENTS AND METHODS: Open label, single-arm, prospective trial. Nine hypogonadal men (testosterone < 300 ng/dL and low/normal LH) with previously treated NFPA. Clomiphene (50 mg/day orally) for 12 weeks. Testosterone, estradiol, LH, FSH, prolactin and erectile function were evaluated before and after 10 days, 4, 8 and 12 weeks of clomiphene treatment. RESULTS: After clomiphene treatment, testosterone and erectile function improved in only one patient. In the remaining eight patients, testosterone levels decreased whereas LH, FSH, and estradiol remained unchanged. Insulin sensitivity increased in unresponsive patients. CONCLUSIONS: Compared with hypogonadal men with prolactinomas under dopaminergic therapy, clomiphene treatment failed to restore normal testosterone levels in most patients with conventionally treated NFPA.

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