Application of recombinant human thrombopoietin in pregnant women with immune thrombocytopenia: a single-center experience of four patients and literature review.

The management of pregnant women with immune thrombocytopenia who fail to respond to corticosteroids and intravenous immunoglobulin is an intractable clinical challenge because of the limited availability of evidence-based information. Recombinant human thrombopoietin (rhTPO) is recommended for refractory immune thrombocytopenia (ITP). To date, however, few studies have investigated rhTPO treatment during pregnancy. We retrospectively reviewed four cases who were diagnosed with ITP and treated with rhTPO during pregnancy in our center from January 2015 to June 2020. Of the four cases, two (50%) responded to rhTPO treatment. No adverse events were noted in the newborns. Our findings indicate that rhTPO treatment is safe for patients with refractory gestational ITP, and that subcutaneous injection is a convenient delivery method that does not lead to adverse events. Thus, rhTPO may be a viable alternative treatment option for patients with refractory gestational ITP who do not respond to first-line therapies.

A first case of successful using of ibrutinib in treating paraneoplastic pemphigus related bronchiolitis obliterans concurrent with CLL.

Paraneoplastic pemphigus (PNP) is a rare life-threatening disease which always associated with an underlying neoplasm. Tumor-related PNP most commonly precedes the detection of a hematological malignancy, with some cases seen during disease remission following cytotoxic drug therapy or radiotherapy. The lung is the most frequently-involved site in PNP, second only to the eyes, and involvement is seen in 59.2% to 92.8% of PNP cases. Bronchiolitis obliterans (BO) is the end stage of respiratory involvement and is regarded as life-threatening. The key point in treatment of PNP is to control the associated underlying hematologic neoplasia. High-dose systemic corticosteroids combined with other immunosuppressants are considered the first line of treatment. Other therapies that have shown beneficial effects include plasmapheresis, intravenous immunogloblin (IVIG), and more recently, daclizumab, alemtuzumab, and rituximab. There is no effective treatment for BO with PNP, and suppression of the cellular immune response may be necessary. Patients with PNP-BO associated with lymphoma mostly die within approximately 1 year. Herein, we reported a patient who diagnosed with PNP-BO concurrent with chronic lymphocytic leukemia. He was successful treated with ibrutinib and had achieved the longest survival which suggested that ibrutinib may be the best treatment choice for such patient.

Linezolid-induced thrombocytopenia in patients with acute myeloid leukemia: a matched case-control study.

PURPOSE: After the wide use of linezolid (LZD), numerous reports of uncontrolled studies have suggested that LZD is associated with high rates of thrombocytopenia. We conducted this matched case-control study to identify the risk factors for LZD-induced thrombocytopenia in patients with acute myeloid leukemia (AML) during the period of myelosuppression. METHODS: We retrospectively retrieved laboratory and clinical data from the medical records of 180 Chinese with AML. Among them, 60 received ≥ 72 h of therapy with LZD during myelosuppression. The remaining patients who did not receive LZD therapy were matched individually in a ratio of 1:2 according to the basic characteristics of the LZD group. RESULTS: We found that in the LZD group, age, history of liver or kidney disease, the baseline level of bilirubin, and creatinine clearance rate (CCR) did not affect the recovery time of platelets. Patients who received LZD for more than 7 days during the period of myelosuppression had a significantly longer time of platelet recovery and platelet count increase. CONCLUSION: The use of LZD > 7 days during the course of myelosuppression and the low level of albumin can prolong the time required for platelet count increase and recovery. Further study is needed to assess the potential adverse effects of LZD in larger AML patient populations.