SEARCH:   Advanced

Prepublished online as a Blood First Edition Paper on August 8, 2002; DOI 10.1182/blood-2001-12-0171. This Article Full Text Full Text (PDF) All Versions of this Article: 2001-12-0171v1 101/1/71    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Huhn, R. D. Articles by Dunbar, C. E. Search for Related Content PubMed PubMed Citation Articles by Huhn, R. D. Articles by Dunbar, C. E. Related Collections Transplantation Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  Blood, 1 January 2003, Vol. 101, No. 1, pp. 71-77 CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS High-dose cyclophosphamide with autologous lymphocyte-depleted peripheral blood stem cell (PBSC) support for treatment of refractory chronic autoimmune thrombocytopenia Richard D. Huhn, Patrick F. Fogarty, Ryotaro Nakamura, Elizabeth J. Read, Susan F. Leitman, Margaret E. Rick, Janice Kimball, Adeira Greene, Kristin Hansmann, Alois Gratwohl, Neal Young, A. John Barrett, and Cynthia E. Dunbar From the Hematology Branch, National Heart, Lung, and Blood Institute, and the Departments of Transfusion Medicine and Laboratory Medicine, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD; and Department of Internal Medicine, University of Basel Kantonsspital, Basel, Switzerland. Patients with refractory chronic autoimmune thrombocytopenia (AITP) have a significant risk of morbidity and mortality related to hemorrhage. High-dose (HD) cytotoxic therapy may produce remissions but entails risks related to myelosuppression. Hematopoietic stem cell support with lymphocyte-depleted grafts may accelerate hematologic recovery and concomitantly reduce repopulation by autoreactive immunocytes. Fourteen patients with chronic AITP, in whom multiple prior therapies including corticosteroids, splenectomy, intravenous immunoglobulin, and various cytotoxic or immunomodulatory regimens had failed, were treated with HD cyclophosphamide (50 mg/kg/d) and autologous granulocyte colony-stimulating factor (G-CSF)-mobilized leukocytes depleted of lymphocytes by immunomagnetic CD34+ selection. There were no significant adverse events related to G-CSF, intravenous device insertion, or leukapheresis. Treatment-related complications included transient hemorrhagic cystitis (1 patient), vaginal bleeding (2 patients), gastrointestinal bleeding (1 patient), epistaxis (1 patient), and antibiotic-responsive febrile neutropenia (all patients). The mean time to absolute neutrophil count (ANC) more than 500/mm3 was 9 ± 0.6 days. Eight patients experienced antibiotic-responsive gram-positive bacteremia. A median of 2 platelet transfusions was required for stem cell mobilization, intravenous catheter insertion, and apheresis and a median of 9 platelet transfusions was required during hematopoietic recovery. Six patients obtained durable complete responses (platelet counts > 100 000/mm3 without other therapy) with maximum follow-up of 42 months. Two additional patients obtained durable partial responses (platelet counts significantly increased over baseline with reduced medication requirements and cessation of bleeding complications). This therapeutic approach is feasible for patients with severe chronic AITP, a substantial proportion of whom may obtain durable remissions. Larger controlled trials are recommended. © 2003 by The American Society of Hematology.   CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: M. Ruggeri, S. Fortuna, and F. Rodeghiero Heterogeneity of terminology and clinical definitions in adult idiopathic thrombocytopenic purpura: a critical appraisal from a systematic review of the literature Haematologica, January 1, 2008; 93(1): 98 - 103. [Abstract] [Full Text] [PDF] E. Elli, M. Parma, P. Perseghin, M. Dassi, E. Terruzzi, D. Belotti, P. Pioltelli, and E.M. Pogliani Successful treatment with T depleted autologous peripheral blood stem cell transplantation of refractory chronic autoimmune thrombocytopenic purpura Haematologica, January 1, 2007; 92(1): e7 - e8. [Abstract] [Full Text] [PDF] S. K. Vesely, J. J. Perdue, M. A. Rizvi, D. R. Terrell, and J. N. George Management of Adult Patients with Persistent Idiopathic Thrombocytopenic Purpura Following Splenectomy: A Systematic Review Ann Intern Med, January 20, 2004; 140(2): 112 - 120. [Abstract] [Full Text] [PDF] R. F. Storb, G. Lucarelli, P. A. McSweeney, and R. W. Childs Hematopoietic Cell Transplantation for Benign Hematological Disorders and Solid Tumors Hematology, January 1, 2003; 2003(1): 372 - 397. [Abstract] [Full Text] [PDF]

	Copyright © 2003 by American Society of Hematology         Online ISSN: 1528-0020