Difference between revisions of "Autoimmune cytopenia"

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| style="width:35%" |<big>Ronak H. Mistry, DO<br>Vanderbilt University<br>Nashville, TN</big><br>[https://www.linkedin.com/in/ronak-mistry-0482864b/ LinkedIn]<br>[[File:Social-twitter-icon.png|frameless|upright=0.1]] [https://twitter.com/rmistry91 @rmistry91]
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''This is an umbrella category that includes Felty's syndrome (autoimmune neutropenia), [[#Autoimmune_thrombocytopenic_purpura_(ITP)|autoimmune thrombocytopenia (ITP)]], [[autoimmune hemolytic anemia (AIHA)]], and Evan's syndrome (AIHA & ITP). Please see the respective page(s) for disease-specific therapies. This page includes regimens that were used more broadly.''
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*''We have moved [[How I Treat]] articles to a dedicated page.''
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|style="width:35%"|<big>[[User:Benjamintillman|Benjamin Tillman, MD]]<br>Vanderbilt University<br>Nashville, TN</big>
 
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''This is an umbrella category that includes Felty's syndrome (autoimmune neutropenia), [[#Autoimmune_thrombocytopenic_purpura_(ITP)|autoimmune thrombocytopenia (ITP)]], [[autoimmune hemolytic anemia (AIHA)]], and Evan's syndrome (AIHA & ITP). Please see the respective page(s) for disease-specific therapies. This page includes regimens that were used more broadly.''
 
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=Guidelines=
 
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=="How I Treat"==
 
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*'''2022:''' Porpaczy & Jäger [https://doi.org/10.1182/blood.2019003686 How I manage autoimmune cytopenias in patients with lymphoid cancer]
 
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=Relapsed or refractory=
 
=Relapsed or refractory=
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==Alemtuzumab monotherapy {{#subobject:34416b|Regimen=1}}==
 
==Alemtuzumab monotherapy {{#subobject:34416b|Regimen=1}}==
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===Regimen {{#subobject:#30ab57|Variant=1}}===
 
===Regimen {{#subobject:#30ab57|Variant=1}}===
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!style="width: 33%"|Study
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!style="width: 25%"|Study
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!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
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!style="width: 25%"|Dates of enrollment
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!style="width: 33%"|[[Levels_of_Evidence#Efficacy|Efficacy]]
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!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
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!style="width: 25%"|[[Levels_of_Evidence#Efficacy|Efficacy]]
 
|-
 
|-
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|[https://onlinelibrary.wiley.com/doi/10.1046/j.1365-2141.2001.03039.x/full Willis et al. 2001]
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|[https://doi.org/10.1046/j.1365-2141.2001.03039.x Willis et al. 2001]
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|1995-11 to 2000-08
 
|style="background-color:#91cf61"|Phase 2
 
|style="background-color:#91cf61"|Phase 2
 
|style="background-color:#b5b5b5"|ORR: 71%
 
|style="background-color:#b5b5b5"|ORR: 71%
 
|-
 
|-
 
|}
 
|}
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<div class="toccolours" style="background-color:#b3e2cd">
 
====Immunosuppressive therapy====
 
====Immunosuppressive therapy====
 
*[[Alemtuzumab (Campath)]] as follows:
 
*[[Alemtuzumab (Campath)]] as follows:
 
**Test dose: 1 mg IV over 60 minutes once
 
**Test dose: 1 mg IV over 60 minutes once
 
**Days 1 to 10: 10 mg IV over 4 hours once per day
 
**Days 1 to 10: 10 mg IV over 4 hours once per day
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'''10-day course'''
 
'''10-day course'''
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</div></div>
 
===References===
 
===References===
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# Willis F, Marsh JC, Bevan DH, Killick SB, Lucas G, Griffiths R, Ouwehand W, Hale G, Waldmann H, Gordon-Smith EC. The effect of treatment with Campath-1H in patients with autoimmune cytopenias. Br J Haematol. 2001 Sep;114(4):891-8. [https://onlinelibrary.wiley.com/doi/10.1046/j.1365-2141.2001.03039.x/full link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/11564082 PubMed]
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# Willis F, Marsh JC, Bevan DH, Killick SB, Lucas G, Griffiths R, Ouwehand W, Hale G, Waldmann H, Gordon-Smith EC. The effect of treatment with Campath-1H in patients with autoimmune cytopenias. Br J Haematol. 2001 Sep;114(4):891-8. [https://doi.org/10.1046/j.1365-2141.2001.03039.x link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/11564082/ PubMed]
  
 
==Sirolimus monotherapy {{#subobject:35516b|Regimen=1}}==
 
==Sirolimus monotherapy {{#subobject:35516b|Regimen=1}}==
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===Regimen {{#subobject:#41ab57|Variant=1}}===
 
===Regimen {{#subobject:#41ab57|Variant=1}}===
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{| class="wikitable sortable" style="width: 80%; text-align:center;"  
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!style="width: 33%"|Study
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!style="width: 25%"|Study
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!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
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!style="width: 25%"|Dates of enrollment
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!style="width: 33%"|[[Levels_of_Evidence#Efficacy|Efficacy]]
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!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
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!style="width: 25%"|[[Levels_of_Evidence#Efficacy|Efficacy]]
 
|-
 
|-
 
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4705607/ Bride et al. 2015]
 
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4705607/ Bride et al. 2015]
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|Not reported
 
|style="background-color:#91cf61"|Phase 2
 
|style="background-color:#91cf61"|Phase 2
 
| style="background-color:#91cf60" |Durable CR observed in patients with ALPS
 
| style="background-color:#91cf60" |Durable CR observed in patients with ALPS
 
|-
 
|-
 
|}
 
|}
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<div class="toccolours" style="background-color:#b3e2cd">
 
====Immunosuppressive therapy====
 
====Immunosuppressive therapy====
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*[[Sirolimus (Rapamune)]] 2 to 2.5 mg/m<sup>2</sup>/day PO
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*[[Sirolimus (Rapamune)]] 2 to 2.5 mg/m<sup>2</sup>/day PO
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**See manuscript for recommended dose adjustments
 
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'''6-month course, extended for those with a favorable response'''
 
'''6-month course, extended for those with a favorable response'''
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</div>
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<div class="toccolours" style="background-color:#fff2ae">
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====Dose and schedule modifications====
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*See manuscript for recommended dose adjustments
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</div></div>
 
===References===
 
===References===
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# Bride KL, Vincent T, Smith-Whitley K, Lambert MP, Bleesing JJ, Seif AE, Manno CS, Casper J, Grupp SA, Teachey DT. Sirolimus is effective in relapsed/refractory autoimmune cytopenias: results of a prospective multi-institutional trial. Blood. 2016 Jan 7;127(1):17-28. Epub 2015 Oct 26. [http://www.bloodjournal.org/content/127/1/17.long link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4705607/ link to PMC article] '''contains protocol''' [https://pubmed.ncbi.nlm.nih.gov/26504182 PubMed]
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# Bride KL, Vincent T, Smith-Whitley K, Lambert MP, Bleesing JJ, Seif AE, Manno CS, Casper J, Grupp SA, Teachey DT. Sirolimus is effective in relapsed/refractory autoimmune cytopenias: results of a prospective multi-institutional trial. Blood. 2016 Jan 7;127(1):17-28. Epub 2015 Oct 26. [https://doi.org/10.1182/blood-2015-07-657981 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4705607/ link to PMC article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/26504182/ PubMed] [https://clinicaltrials.gov/study/NCT00392951 NCT00392951]
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[[Category:Autoimmune cytopenia regimens]]
 
[[Category:Autoimmune cytopenia regimens]]
 
[[Category:Disease-specific pages]]
 
[[Category:Disease-specific pages]]
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[[Category:Hemolytic process]]
 
[[Category:Hemolytic process]]
 
[[Category:Cytopenias]]
 
[[Category:Cytopenias]]
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[[Category:Clinical pharmacology]]
 

Latest revision as of 11:07, 6 July 2024

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Section editor
Tillman Benjamin-2.jpg
 Benjamin Tillman, MD
Vanderbilt University
Nashville, TN, USA
LinkedIn

This is an umbrella category that includes Felty's syndrome (autoimmune neutropenia), autoimmune thrombocytopenia (ITP), autoimmune hemolytic anemia (AIHA), and Evan's syndrome (AIHA & ITP). Please see the respective page(s) for disease-specific therapies. This page includes regimens that were used more broadly.

  • We have moved How I Treat articles to a dedicated page.
2 regimens on this page
2 variants on this page


Relapsed or refractory

Alemtuzumab monotherapy

Regimen

Study Dates of enrollment Evidence Efficacy
Willis et al. 2001 1995-11 to 2000-08 Phase 2 ORR: 71%

Immunosuppressive therapy

  • Alemtuzumab (Campath) as follows:
    • Test dose: 1 mg IV over 60 minutes once
    • Days 1 to 10: 10 mg IV over 4 hours once per day

10-day course

References

  1. Willis F, Marsh JC, Bevan DH, Killick SB, Lucas G, Griffiths R, Ouwehand W, Hale G, Waldmann H, Gordon-Smith EC. The effect of treatment with Campath-1H in patients with autoimmune cytopenias. Br J Haematol. 2001 Sep;114(4):891-8. link to original article contains dosing details in manuscript PubMed

Sirolimus monotherapy

Regimen

Study Dates of enrollment Evidence Efficacy
Bride et al. 2015 Not reported Phase 2 Durable CR observed in patients with ALPS

Immunosuppressive therapy

6-month course, extended for those with a favorable response

Dose and schedule modifications

  • See manuscript for recommended dose adjustments

References

  1. Bride KL, Vincent T, Smith-Whitley K, Lambert MP, Bleesing JJ, Seif AE, Manno CS, Casper J, Grupp SA, Teachey DT. Sirolimus is effective in relapsed/refractory autoimmune cytopenias: results of a prospective multi-institutional trial. Blood. 2016 Jan 7;127(1):17-28. Epub 2015 Oct 26. link to original article link to PMC article contains dosing details in abstract PubMed NCT00392951
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