Outcome of Splenectomy On Adult Idiopathic Thrombocytopenic Purpura (ITP)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4690-4690
Author(s):  
Tarun K. Dutta ◽  
Vishnu Vy ◽  
Debdatta Basu
Keyword(s):  
Complete Remission ◽  
Drug Treatment ◽  
Conflicts Of Interest ◽  
Line Treatment ◽  
Inclusion Criteria ◽  
Thrombocytopenic Purpura ◽  
Prospective Group ◽  
Secondary Failure ◽  
Fair Chance

Abstract Abstract 4690 Aim: To study outcome of splenectomy on adult ITP patients (both in prospective and retrospective groups) Patient and Methods: Two groups of ITP patients were studied. They were as follows: (i) Retrospective group – Twenty two patients who underwent splenectomy during last twenty one years (ii) Prospective group – All patients admitted during last three years with a minimum follow-up of six months (29 patients) Result: Retrospective group: Twenty two patients had undergone splenectomy during last twenty one years. Median time from diagnosis to splenectomy was 32 months. Median platelet count was 28,000/μl with some form of drug treatment (before undergoing splenectomy). Median post-splenectomy follow-up was 54 months (maximum 252 months). Eleven (50%) patients had either primary failure or relapse following splenectomy during subsequent years. The cumulative break-up figure was as follows: Primary failure – 3 (13.6%) At 24 months – 7 (31.8%) At 5 years – 9 (40.9%) At 10 years – 11(50%) Prospective group: Out of 29 patients of ITP enrolled according to inclusion criteria of minimum six months’ follow-up, 20 had complete remission with steroids; nine had primary failure. Out of 20 patients with complete remission, two had relapse within six months of remission. Out of total 11 patients with failure to response to steroids (nine primary failure and two secondary failure), six patients agreed to undergo splenectomy. Three patients had complete remission till last follow-up (maximum follow-up was for 23 months). Two had primary failure following splenectomy and one had relapse. Five patients who did not agree for splenectomy are in complete or partial remission with azathioprine. Conclusion: At the end of two years in retrospective group, almost one-third of 22 patients who underwent splenectomy had either primary failure or relapse. Similarly in prospective group, though small in number, at the end of 23 months itself, three of six patients who underwent splenectomy had either no response or had relapsed. Thus this study questions the utility of splenectomy as second-line treatment after steroid failure. Rather, patient may be given a choice to opt for other form of drug treatment after steroid failure and advised splenectomy as and when unavoidable. Nevertheless, any patient opting for splenectomy should be cautioned that there is a fair chance of relapse later in life. Furthermore, it appears incidence of relapse following splenectomy is higher in Indian patients as compared to that in the Western patients. Disclosures: No relevant conflicts of interest to declare.

Common late complications of longitudinal forefoot amputations in neuropathic foot treatment

2021 ◽  
Vol 30 (6) ◽  
pp. 498-503
Author(s):  
Rodrigo Sousa Macedo ◽  
Lucas Sousa Macedo ◽  
Marcos Hideyo Sakaki ◽  
Rafael Barban Sposeto ◽  
Rafael Trevisan Ortiz ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Reoperation Rate ◽  
Late Complications ◽  
Inclusion Criteria ◽  
Patients With Diabetes ◽  
Partial Amputation ◽  
Neuropathic Foot ◽  
Foot Clinic ◽  
Ray Amputation

Objective: To describe and quantify the complications arising in consecutive neuropathic patients undergoing partial longitudinal amputations of the foot. Method: A retrospective study was conducted with data collected from the medical records of patients monitored at the Insensitive Foot Clinic of the Foot and Ankle Group of our institution who underwent partial amputation of foot rays from 2000 to 2016. Results: A total of 28 patients met the inclusion criteria, with a total of 31 amputated/partially amputated feet. Of these, 18 (58.1%) feet were amputated/partially amputated due to diabetes, seven (22.6%) due to leprosy, two (6.5%) due to alcoholic neuropathy, two (6.5%) secondary to traumatic peripheral nerve injury, and two (6.5%) due to other causes. Fifth ray amputation was the most frequent type (n=12). The cause of amputation was the presence of an infected ulcer in 93.6% of the samples. At a mean follow-up time of 60 months, 13 (41.9%) feet required new amputations—five (38.5%) transtibial, five (38.5%) transmetatarsal, two (15.4%) of the toes, and one (7.7%) at Chopart's joint. Patients with diabetes had a 50.0% reamputation rate. Patients who initially underwent amputation of the fifth ray had a 58.3% reamputation rate. Conclusion: Partial longitudinal amputation of the foot in neuropathic patients exhibited a high reoperation rate, especially in patients with diabetes or in patients with initial amputation of the peripheral rays. Declaration of interest: The authors have no conflicts of interest.

Fibrosis in Nodular Sclerosis Hodgkin Lymphoma Is Predictive of a Residual Mass Following Therapy.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4630-4630
Author(s):  
Alanna J Church ◽  
Nasim Shabazi ◽  
David LeBrun ◽  
Tara Baetz
Keyword(s):  
Hodgkin Lymphoma ◽  
Functional Imaging ◽  
Conflicts Of Interest ◽  
Post Treatment ◽  
Line Treatment ◽  
Residual Mass ◽  
Nodular Sclerosis ◽  
Residual Masses ◽  
Initial Biopsy

Abstract Abstract 4630 Persistence of a mass after first-line treatment is a common problem in nodular sclerosis Hodgkin lymphoma (NSHL). Up to 64% of patients demonstrate residual abnormalities on computed tomography (CT) after therapy, but only 42% of those patients will relapse on follow-up. This is primarily caused by the inability of CT to distinguish viable tumor tissue from fibrosis. Clinicians are faced with the dilemma of whether to pursue second-line treatment for a mass that may be simply scar tissue. The ability to predict which patients are at higher risk for residual mass following curative treatment can aid in the planning of follow-up imaging modalities such as positron emission tomography (PET) scanning which can map out metabolically active tissue (i.e. tumor versus fibrosis) and the need for biopsy of a residual mass. This study was designed to test the hypothesis that the presence of abundant fibrosis in the initial biopsy predicts the presence of residual, post-therapy masses composed primarily of fibrotic tissue. Subjects were consecutive NSHL patients from the years 1996 to 2007 identified from our institution based on the availability of histology slides from the initial diagnostic biopsy, clinical follow-up data, and the results of post-treatment imaging investigations. The initial biopsies were reviewed by a lymphoma pathologist and resident without knowledge of the residual mass status. The proportion of the tissue consisting of fibrous material was graded as a percentage of the total biopsy tissue. The clinical charts were reviewed for baseline patient characteristics, cancer stage and the presence of a residual mass on CT scan 6 months after treatment. Of the 47 subjects included in the study, 25 had residual masses and 22 had none. Patients with increased fibrosis on initial biopsy were significantly more likely to have a residual mass after initial therapy (p=0.028). The degree of fibrosis was independent of gender, stage, and Hasenclever score. Degree of fibrosis was the only factor that was predictive of the presence of a residual mass. Of the 16 patients with residual masses with follow-up Gallium imaging, the result of the scan was more likely to be negative (indicating that the mass is not metabolically active) for patients with a high grade of initial fibrosis (p=0.148). Taken together, these results suggest that patients with increased fibrosis on their initial NSHL biopsy are more likely to have residual masses, but that these masses are less likely to be malignant. The results support the hypothesis that the degree of fibrosis at the initial NSHL biopsy is predictive of a post-treatment residual mass. These findings have potential implications for patient follow-up: clinicians whose patients have abundant fibrosis at initial biopsy may be reassured that a post-treatment residual mass is less likely to represent persistent malignancy and thus can be followed with functional imaging rather than pursuing unnecessary biopsies. Our results further reinforce the importance of functional imaging like PET, particularly in this patient population Disclosures: No relevant conflicts of interest to declare.

Reduced Intensity Conditioning (RIC) Allogeneic Stem Cell Transplantation (allo-SCT) in Patients with Haematological Lymphoid Malignancies: Long Term Follow-up in a Single Centre Series.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4326-4326
Author(s):  
Malek Benakli ◽  
Redhouane Ahmed nacer ◽  
Amina Talbi ◽  
Rachida Belhadj ◽  
Farih Mehdid ◽  
...  
Keyword(s):  
Complete Remission ◽  
Hodgkin Lymphoma ◽  
Median Time ◽  
Conflicts Of Interest ◽  
Late Onset ◽  
Chronic Gvhd ◽  
Conditioning Regimen ◽  
Lymphoid Leukaemia ◽  
Autologous Transplant

Abstract Abstract 4326 Background Patients (pts) with recurrent and refractory haematological lymphoid malignancy (HLM) have a very limited survival expectance. RIC allo-SCT has been proposed as a strategy for retaining the graft versus malignancy effect of allo-SCT while decreasing transplant related mortality (TRM). Here, we retrospectively studied a series of 32 pts treated by RIC allo-SCT. Patients and methods Between April 2001 and November 2007, 32 pts with HLM underwent RIC allo-SCT with an HLA-identical sibling donor. Fifteen pts with multiple myeloma, 7 pts with Non-Hodgkin lymphoma, 6 pts with Chronic lymphoid leukaemia, 3 pts with Hodgkin lymphoma and 1 pt with Waldenstrom disease. At time of allo-SCT, 10 pts were in complete remission (3 received prior autologous transplant) and 22 in refractory/progressive disease (6 received prior autologous transplant). Median age was 38 years (range, 28-60) and the sex-ratio (M/F) 2,2. Median time from diagnosis to RIC allo-SCT was 18 (range,6-76) months. The conditioning regimen included Fludarabine 150mg/m2 and Melphalan 140mg/m2. GVHD prophylaxis consisted of association cyclosporine (cSA) and mycophenolate (MMF). All pts received G-CSF mobilised peripheral blood stem cells, with a median CD34+ cell count: 6,2.106/kg (range, 1.9-13,6). Results Neutropenia occurred in all pts (100%) and the median duration of aplasia was 9 (range, 5-16) days. Only 10 pts (31 %) required red blood cells transfusions and 23 pts (71 %) needed platelets transfusions. Acute GVHD was observed in 15 cases (47 %) including 10 cases of grade II-IV. Fifteen pts (75 %) had chronic GVHD, of whom 9 with an extensive form. Four pts (12 %) had CMV reactivation at a median time 60 (range, 52-80) days after transplantation. Six pts (18 %) had late onset relapse at a median time of 13 (range, 4-45) months. TRM was 43 % at one year after RIC allo-SCT. With a median follow-up of 60 (range 18-97) months, 12 pts (37,5 %) are still alive in complete remission with full donor chimerism. Twenty pts (62,5 %) have died (5 early severe infections, 10 GVHD, 3 after relapse, one myocardial infarction, and one accident). Overall and progression-free survivals at 8 years are 31 % and 30 % respectively. Conclusion This study, after a large follow-up, suggests that RIC allo-SCT is a potential therapy for refractory or progressive HLM. However, TRM is still high likely due to the inclusion of refractory and heavily pretreated pts with many comorbid conditions. Disclosures: No relevant conflicts of interest to declare.

Outcome of Patients with Multiple Myeloma (MM) After 1st Relapse Following Front-Line Treatment with Autologous Stem Cell Transplantation (ASCT): Impact of Early Reduced Intensity Allogeneic Transplantation (RICALLO)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4533-4533
Author(s):  
Reza Tabrizi ◽  
Stephane Vigouroux ◽  
Gerald Marit ◽  
Arnaud Pigneux ◽  
Cyril Melot ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Autologous Transplantation ◽  
Allogeneic Transplantation ◽  
Line Treatment ◽  
Inclusion Criteria ◽  
Front Line ◽  
Entire Cohort ◽  
Single Center Study ◽  
First Relapse ◽  
Time To Relapse

Abstract Abstract 4533 The aim of this single center study was to assess the outcome of pts with MM following the first relapse after autologous transplantation, according to whether or not a RICALLO was performed early in 2d response. Records of the patients were reviewed and the criteria for entering the study were: Symptomatic MM treated frontline with a program including single or double ASCT, relapse at any time following ASCT, response (CR, VGPR or PR) to a second line treatment. RICALLO was proposed to pts with no significant co-morbidities, having a suitable donor (either sibling or 10/10 MUD) and who gave their consent after precise information on the risk of the RICALLO. One hundred and seven pts treated between 01/2004 and 02/2011 fulfilling the inclusion criteria were identified. The initial treatment for relapse consisted of VD (37 pts), RD (29 pts), TD (36 pts), VTD (4 pts) or autologous SCT (1 pt). 22 pts received a RICALLO (allo group) while in 2d response, a median 7.7 months (2–36) after relapse. The RIC consisted of fludarabine plus either 2Gy ICT or busulfan and ATG (according to ongoing available protocols in the centre). The graft was PBSC from sibling (N: 8) or MUD (N: 14). 85 pts (CT group) received therapies according to ongoing protocols or available standard of cares. Following further relapses, 11 pts received a RICALLO while in ≥ 3d response in the CT group. The main characteristics of the patients in each group: age, MM prognostic factors at diagnosis, type of 1st line therapy (VAD or bortezomib containing regimens), single or double ASCT, time to relapse after ASCT and 2d line treatment were similar between the 2 groups. The response achieved with 2d line treatment was different between 2 groups (CR + VGPR/other: 8/14 and 7/76 in allo and CT group respectively, p= 0.01) The 3y OS from the time of relapse for the entire cohort was: 47% (CI95%, 41–53). It was of 45% (CI95% 34–56) and of 48% (CI95% 41–55) for the allo group and the CT group respectively (p= ns). The median time from 1st relapse to death was 31 mo in the entire cohort and 20 and 34 mo in the allo group and CT group respectively (p= ns). The causes of death were, relapse in 5 and 33 pts, or treatment toxicity in 8 and 3 pts in the allo group and CT group respectively. Three 3 y EFS (event = 2d relapse or death) was 16% (CI95%, 11–21) for the whole cohort and 16% (CI95%, 6–26) and 19% (CI95%, 13–25) for the allo group and CT group respectively (p= ns). Conclusion: In conclusion, we did not observe any difference in survival or PFS between allo-SCT and CT in patients at first relapse following an auto SCT. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Diagnosis and Treatment of Polycythemia Vera (PV) in Russian Federation: Single Center Experience

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5196-5196
Author(s):  
Irina N. Subortseva ◽  
Tamara I Kolosheinova ◽  
Elena I Pustovaya ◽  
Elena K. Egorova ◽  
Alla M. Kovrigina ◽  
...  
Keyword(s):  
High Risk ◽  
Complete Remission ◽  
Russian Federation ◽  
Conflicts Of Interest ◽  
Cell Mass ◽  
Outpatient Department ◽  
Symptomatic Therapy ◽  
Thrombotic Risk

Abstract Background: PV is a chronic myeloproliferative neoplasm (MPN) characterized by predominant proliferation of erythroid precursors, an elevated red blood cell mass, high risk of vascular and thrombotic complications, reduced quality of life due to a substantial symptom burden (pruritus, fatigue, constitutional symptoms, microvascular disturbances, and bleeding). Conventional therapeutic options aim at reducing vascular and thrombotic risk, with low-dose aspirin and phlebotomy as first-line recommendations for patients at low risk of thrombotic events and cytoreductive therapy (hydroxyurea or interferon alpha) recommended for high-risk patients. Long-term effective and well-tolerated treatments are still lacking. Few data are available concerning patients with this condition at Russian Federation. The aim of this study was to describe clinical and demographic characteristics of PV patients at diagnosis and review the current treatment landscape in PV. Methods: From 2004 to 2014 in the outpatient department of Hematology Research Center 1687 patients with MPN were observed. The proportion of patients with PV was 28% (470) PMF - 31% (523), ET - 23% (389), unclassified MPN - 18% (305). We present the results of observation of 100 patients with PV who treated in the outpatient department. Long-term follow up of patients ranged from 6 to 262 months. Median follow-up - 14 months. Results: The proportion of women was 67%, men - 33%. The age was from 23 to 80 years (median - 56 years). PV diagnosed on the classification of WHO 2008. Hemoglobin was from 149 to 260 g/L (median 181 g/L) in men, hemoglobin was from 136 to 247 g/L (median 177 g/L) in women. RBC was 4.4 - 10.0x1012/L (median 7,1x1012/L) in men, RBC 4.8 - 8.8 x1012/L (median 6,9x1012/L) in women. PLT 137 - 3934 hч109/L (median 551x109/L), WBC 4.0 - 69x109/L (median 10,5x109/L). Hematocrit 42 - 86% (median 53%). JAK2 V617F detected in 100%. Splenomegaly founded in 70%. All patients had headache, dizziness, 25% of patients - itching. All patients received symptomatic therapy, antiplatelet agents, preparations improving microcirculation and antihypoxants. 25% patients had thrombohemorrhagic complications in anamnesis. Treatment: 49% - hudroxiurea, 14% - INFα-2b, 14% - combination therapy (hydroxyurea and phlebotomy or INFα-2b and phlebotomy), 23% - only phlebotomy. Response to treatment was evaluated according to the criteria of the ELN 2009. In the whole group of patients without the therapy frequency of complete remission - 48% partial remission - 41%, with no effect - 11%. Change of therapy was carried out in case of failure, intolerance or treatment of complications. When switching treatment from one method to another complete remission was not achieved. Conclusion: Treatment of polycythemia is mainly symptomatic. The effectiveness of therapy I line (complete remission) from 14.5 to 71%. It is necessary to conduct clinical trials designed to evaluate the effectiveness and safety of new targeted therapies. Disclosures No relevant conflicts of interest to declare.

Primary Granulocytic Sarcoma:A Allo-Transplantation Case Report and Literature Review.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4368-4368
Author(s):  
Xiaolin Li ◽  
Jie Fu ◽  
Yan Xue ◽  
Yang Yang ◽  
Yang Wang ◽  
...  
Keyword(s):  
Case Report ◽  
Complete Remission ◽  
Literature Review ◽  
Conflicts Of Interest ◽  
Granulocytic Sarcoma ◽  
Allogeneic Transplantation ◽  
Radical Operation ◽  
Matched Sibling ◽  
Granulocytic Leukemia

Abstract Abstract 4368 Objective To investigate the effect of allogeneic transplantation in treating primary granulocytic sarcoma. Methods We report the diagnosis and treatment of one patient with primary granulocytic sarcoma and review the related articles. Results Firstly appeared as one isolated tumor in breast, the disease was diagnosed by pathological methods with immunochemistry positive stain in MPO, CD68(KP-1) and bacteriolysis enzyme. After radical operation on sick breast, the patient was treated with four courses chemotherapy according to that of acute granulocytic leukemia,then followed by matched sibling transplantation. After 6 months follow-up, the patients is still in complete remission. Conclusion If having suitable donor, patient with primary granulocytic sarcoma shoud be treated with allogeneic transplantation. Disclosures: No relevant conflicts of interest to declare.

Rituximab Treatment in Childhood Chronic Immune Thrombocytopenic Purpura (ITP).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4461-4461 ◽  
Author(s):  
Ji Yoon Kim ◽  
Kun Soo Lee ◽  
Hyoung Jin Kang ◽  
Hoon Kook ◽  
Hong Hoe Koo ◽  
...  
Keyword(s):  
Platelet Count ◽  
Immune Thrombocytopenic Purpura ◽  
Medical Records ◽  
Conflicts Of Interest ◽  
Complete Response ◽  
Thrombocytopenic Purpura ◽  
Chronic Itp ◽  
New Treatment ◽  
Lost To Follow Up

Abstract Abstract 4461 Background Immune thrombocytopenic purpura (ITP) is characterized by mucocutaneous purpura and thrombocytopenia caused by circulating anti-platelet auto-antibodies. ITP is usually self-limited in children, but around 20% of patients will develop chronic ITP. The conventional treatments for children chronic ITP include intravenous immunoglobulin (IVIG), corticosteroid therapy, anti-D immune globulin, or splenectomy. Some children with chronic ITP are refractory to these treatments and nowadays begun to try new treatment agents such as rituximab. Rituximab as a monoclonal antibody to CD-20, has shown promising reports to these patients with refractory chronic ITP in adults groups and a few children groups. We investigated this study to evaluate the efficacy of rituximab for childhood chronic ITP in Korea. Methods We reviewed the questionnaires and medical records about the clinical progresses and results in thirteen children from eight clinical institutes, retrospectively. Complete response (CR) was considered if the platelet count was > 100,000/uL. Results Thirteen patients with chronic thrombocytopenia who had been treated with rituximab were investigated. Two patients were lost to follow-up after rituximab. Finally eleven patients were evaluated including one patient with Evans syndrome. Median age was 6.5 year (range, 0.5 ∼ 15.4). Median platelet count at baseline was 13,700/uL (3,000∼46,000). All patients had been treated with conventional therapy including IVIG and steroids. One had done splenectomy. Median follow-up duration was 2.8 years (1.1-5.9). Among 11 patients, CR was achieved in 3 patients (27%). Their platelet count prior to rituximab were < 10,000/uL. They were treated as the regimen of 375 mg/m2/dose weekly for 4 doses. Time from the first rituximab dose to achievement of complete response was 3.9, 4.9 and 5.7 weeks respectively. One patient who was relapsed 6months after the first course of rituximab was received second course of rituximab using the same regimen and achieved a new CR at 9.3 weeks after. There were no reports about severe complication or interruption of medication. Conclusions Therefore, we suggest that rituximab is effective treatment choice in childhood refractory chronic ITP and well tolerated. Disclosures: No relevant conflicts of interest to declare.

New Cases of Acute Promyelocytic Leukemia Treatment by Arsenic Trioxide Alone and Their Long Term Follow up

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 506-506 ◽  
Author(s):  
Ardeshir Ghavamzadeh ◽  
Kamran Alimoghaddam ◽  
Shahrbano Rostami ◽  
Seyed Hamidolah Ghaffari ◽  
Mohamad Jahani ◽  
...  
Keyword(s):  
Complete Remission ◽  
Arsenic Trioxide ◽  
Conflicts Of Interest ◽  
Promising Result ◽  
Single Agent ◽  
Disease Free Survival ◽  
Long Term Follow Up ◽  
Wbc Count

Abstract Abstract 506 Long term follow-up of APL patients treated by ATRA and chemotherapy is available and shows promising results of DFS and OS. Although several studies show acceptable efficacy of Arsenic Trioxide in new cases of APL, its long term result needs better clarification. Materials and methods: one hundred ninety seven, new cases of APL treated by Arsenic trioxide (0.15 mg/kg daily i.v infusion till complete remission). After achieving to CR patients received 4 more courses of Arsenic trioxide as consolidation. Then patients followed by CBC and RT-PCR on peripheral blood for detection of MRD every three months or till relapse or death. Results: Morphologic complete remission rate was 85.8% and most common cause of remission failure was early death due to hemorrhage of APL differentiation syndrome.(14.7%) Most important prognostic factor for early mortality is high WBC count at presentation. Disease free survival was 90%+/−2%, 72.7%+/−3% and 66.7%+/−4% for 2, 3 and 5 years respectively. Relapse for patients who remained in CR after 5 years was very uncommon. Overall survival for patients after diagnosis by intention to treat analysis was 80.2%+/−3%, 75.9%+/−3% and 64.4%+/− 4% for 2, 3 and 5 years. Also OS and DFS were the same between patients with high and low WBC count. Conclusion: Long term follow up of newly diagnosed cases of APL, treated with single agent Arsenic Trioxide shows promising result. Arsenic trioxide potentially eliminates the adverse effect of prognostic factors of APL treatment such as high WBC count. We suggest that it is time to integrate Arsenic trioxide in treatment of new cases of APL. Disclosures: No relevant conflicts of interest to declare.

Rituximab Does Not Prevent Relapse in Patients with Thrombotic Thrombocytopenic Purpura

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3318-3318
Author(s):  
Goyal Jatinder ◽  
Jose L. O. Lima ◽  
Jill Adamski ◽  
Marisa Marques
Keyword(s):  
Thrombotic Thrombocytopenic Purpura ◽  
Medical Records ◽  
Conflicts Of Interest ◽  
Univariate Analysis ◽  
Laboratory Data ◽  
Delayed Response ◽  
Thrombocytopenic Purpura ◽  
Group 2 ◽  
Group 1

Abstract Abstract 3318 Objective: In the last decade, rituximab has been added to therapeutic plasma exchange (TPE) to treat patients with thrombotic thrombocytopenic purpura (TTP) who appear resistant to TPE. We sought to determine first if rituximab prevented TTP relapse. In addition, if relapse has occurred, we compared the rates of relapse of patients treated with TPE alone with those treated with a combination of TPE and rituximab. Methods: We retrospectively reviewed the medical records of all adult patients treated for TTP between 2003 and 2008 at our institution. TTP was defined as thrombocytopenia, hemolytic anemia and ADAMTS13 activity less than 10% due to an inhibitor. None of the patients had congenital TTP. Patient demographics, laboratory data, treatment characteristics and follow up details were collected from their electronic and apheresis' medical records. Kaplan-Meier curves were drawn for survival and Cox proportional hazards models were applied to look for independent predictors of relapse-free survival (RFS). Results: A total of 20 patients underwent TPE only (Group 1) as compared to 18 patients who also received rituximab during admission with TTP (Group 2). Table 1 shows that both groups were balanced at baseline for demographic and laboratory data. However, patients in group 2 had longer duration of hospital stay (p<0.0001), underwent more TPE procedures (p<0.0001) and took longer to achieve remission (p<0.0001). The mean follow up in group 1 was 77.5 (±22.4) months and in group 2 was 68.6 (±28.5) months. At follow-up, 5 patients from group 1 relapsed (25%) as compared with 6 patients from group 2 (35%) (p=0.50). The 1-year, 3-year and 5-year RFS rates were 95%, 85% and 74% for group 1, and 94%, 76% and 71%, respectively, for group 2 (p=0.53 using log rank test). On univariate analysis, only age at the time of treatment (p=0.05) and duration of follow-up after treatment (p=0.03) were predictors of relapse. However, on multivariate analysis, no independent predictors of relapse were identified. Conclusion: Rituximab does not prevent or reduce rates of relapse when used with TPE in patients with TTP. Since rituximab was added to patients later in their TPE course due to delayed response to treatment, it may yet have a role in decreasing the number of TPEs needed to achieve a response if it were started earlier during hospitalization for TTP. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Can Rituximab Improve the Outcome of Patients with Nodular Lymphocyte-Predominant Hodgkin's Lymphoma?

2015 ◽  
Vol 134 (3) ◽  
pp. 187-192 ◽  
Author(s):  
Heidi Mocikova ◽  
Robert Pytlik ◽  
Pavla Stepankova ◽  
Jozef Michalka ◽  
Jana Markova ◽  
...  
Keyword(s):  
Complete Remission ◽  
Partial Remission ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Line Treatment ◽  
Second Line ◽  
Treatment Results ◽  
Cd20 Expression

Background: Nodular lymphocyte-predominant Hodgkin's lymphoma (NLPHL) is a rare subtype of Hodgkin's lymphoma showing strong CD20 expression. The role of rituximab in treating NLPHL still needs clarification. Methods: We retrospectively reviewed the outcome of 23 patients with NLPHL treated with rituximab alone or in combination with chemotherapy and/or radiotherapy as part of their first- or second-line treatment. Results: The median follow-up of the whole group was 67 months, and all patients remained alive. Twenty-two patients achieved complete remission after rituximab-based therapy, and one of them relapsed 32 months after treatment. One patient treated with rituximab alone achieved partial remission and progressed 22 months after treatment. Conclusion: The prognosis of NLPHL is excellent. Rituximab combined with chemotherapy and/or radiotherapy appears to prevent disease progression/relapse.

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