A Novel Anti-CD38 Monoclonal Antibody for Treating Immune Thrombocytopenia
This is a promising new agent for ITP, where the median time of 50K platelets is one week. This is a small study though, awaiting more data in the future.
Introduction to a How I Treat series on management of high-risk patients following allogeneic transplant
Author(s): Robert Zeiser
Source: Blood (2023) 141 (1): 1.
Dr. Anjan Patel's Thoughts
Interesting prospective study assessing outcomes in ITP in pregnant women while measuring neonatal ITP in the developing child, with a control of non-pregnant women for comparison. Pregnancy-ITP was associated with a 2.7x higher rate of recurrent disease. However, bleeding was similar in pregnant vs. non-pregnant women. NITP risk was associated with more severe ITP disease in the mother and the severity of the disease, as well as prior h/o ITP in the mother.
To improve the therapeutic success of allogeneic hematopoietic cell transplantation (allo-HCT), the management of high-risk patients is essential. High risk means high likelihood for development of graft-versus-host disease (GVHD), for relapse of the underlying malignancy, and for severe infectious complications. The following How I Treat series describes state-of-the art and major recent developments in the management of prevention of relapse with cellular therapies or maintenance-based approaches and GVHD prophylaxis.
- Alexander Biederstädt and Katayoun Rezvani, “How I treat high-risk acute myeloid leukemia using preemptive adoptive cellular immunotherapy”
- Zachariah DeFilipp and Yi-Bin Chen, “How I treat with maintenance therapy after allogeneic HCT”
- Joseph Rimando, Shannon R. McCurdy, and Leo Luznik, “How I treat GVHD in high-risk patients: posttransplant cyclophosphamide and beyond”
Related Articles
Eltrombopag for Low-Risk Myelodysplastic Syndromes With Thrombocytopenia: Interim Results of a Phase II, Randomized, Placebo-Controlled Clinical Trial (EQOL-MDS)
This great Italian study uses eltrombopag in patients with low/intermediate risk MDS. The intervention arm had significantly fewer minor bleeding events and better platelet counts that were durable. Those with higher baseline Hb’s seemed to respond better to therapy, particularly if the Hb was >8g/dL. AML evolution/blast progression was not more common in the treatment arm, which refutes some prior concerns.
Prolonged response after TPO-RA discontinuation in primary ITP: results of a prospective multicenter study
Benign heme article of the month– A significant portion of patients with stable platelet counts can be gently tapered from TPO-agonists. Those who needed to be re-challenged had a good response. This is likely an underutilized strategy.
The role of CD8+ T-cell clones in immune thrombocytopenia
Thought provoking article regarding a non-antibody mediated mechanism in chronic ITP.
Efficacy and Safety of Intravenous Efgartigimod in Adults with Primary Immune Thrombocytopenia: Results of a Phase 3, Multicenter, Double-Blinded, Placebo-Controlled, Randomized Clinical Trial (ADVANCE IV)
Another new (potential) option for refractory ITP patients, efgartigimod is an IgG1-Fc-fragment engineered to reduce IgG autoantibody levels. 131 patients enrolled and 67% had >=3 prior lines of therapy, placebo controlled study. The study group had a 90% sustained platelet response, with >50% having plt counts of >30k >= 7 days apart.