İmmun Trombositopenili Hastalarda Dörtlü Tedavi

Abstract

Amaç:İmmün trombositopeni tedavisinde son yıllarda deksametazon, rituksimab ve siklosporin kombinasyon tedavileri umut verici sonuçlar vermiştir. Bu çalışmada, immün trombositopenide verilen kombinasyon tedavilerinin eltrombopag ile birleştirilmesiyle oluşturulan dörtlü tedavinin hastalardaki yanıtlarının araştırılması amaçlanmıştır. Yöntem:İmmun trombositopeni tanısı almış birinci basamak tedavide steroid, 2.basamak tedavide eltrombopag alan, tam ya da kısmı remisyon sağlanamayan 4 hasta retrospektif olarak aldıkları tedavi ve yanıt oranları açısından değerlendirdi. Sonuç:Relaps /refrakter immün trombositopenisi olan hastalar, eltrombopag tedavisine ek olarak oral deksametazon, oral siklosporin ve intravenöz düşük doz rituksimab ile tedavi edildi. Eltrombopag tedavisine 50 mg/gün dozunda devam edildi. Siklosporin için yükleme dozu verilmedi, haftalık kan siklosporin düzeyi toksisite açısından izlendi ve tedavi 200 ile 400 µg/L'lik bir hedef doza titre edildi. Toksisite kaynaklı ölüm, tedaviye bağlı ciddi advers olaylar veya tedaviye uyumsuzluk gözlenmedi. 6 aylık yanıt oranı %75 idi ve tedavi iyi tolere edildi. Hastalarımızdan iki tanesi halen tam yanıtlı olarak tarafımızca takipli iken bir hastamızda 6.aydan sonra relaps olması nedeniyle splenektomi yapılmış olup halen eltrombopag tedavi ile takiplidir. Yanıtsız olan daha önce splenektomili olan hastamıza ise romiplastim tedavisi uygulandı ancak bu tedaviye de yanıt alınamadı. Hasta klinik çalışmaya dahil edildi. Sonuç:Tedaviye dirençli immün trombositopenili hastalarda dörtlü tedavi kombinasyonunun bir tedavi seçeneği olabileceğini gösteren çalışmamız umut vaad etmektedir.

Keywords

• immun trombositopeni
• eltrombopag
• dörtlü tedavi

Quadruple Therapy in Patients with Immune Thrombocytopenia

Abstract

Objective:In the treatment of immune thrombocytopenia dexamethasone, rituximab, and cyclosporine combination therapies provided promising results in recent years. This study aimed to investigate the responses of patients with quadruple therapy which created by combining combinational therapies given in immune thrombocytopenia with eltrombopag. Method: Four patients diagnosed with immune thrombocytopenia who received steroid in the first-line treatment and eltrombopag in the second-line treatment without achieving complete remission/partial remission were retrospectively evaluated in terms of the treatment they received and response rates. Result:Patients with relapsed/refractory immune thrombocytopenia were treated by oral dexamethasone, oral cyclosporine and intravenous low-dose rituximab in addition to eltrombopag therapy. Eltrombopag treatment was continued at a dose of 50mg/day. No loading dose was given for cyclosporine, weekly blood cyclosporine level was monitored for toxicity and the treatment was titrated to a target dose of 200 to 400 μg/L. No toxicity-induced death, serious treatment-related adverse events, or non-adherence to treatment were observed. The 6-month response rate was 75% and the treatment was well tolerated. Two patients were still followed up by us with a complete response, while one our patient underwent splenectomy because of relapse after 6 months and is still being followed up with eltrombopag therapy. In one our patient, which was unresponsive, romiplastim treatment was applied but there was no response to this treatment either. The patient was referred to a clinical study Conclusion: Our study showing that a combination of quadruple therapy can be a treatment option in patients with treatment-resistant immune thrombocytopenia is promising.

Keywords

• immune thrombocytopenia
• eltrombopag
• quadruple therapy

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