Splenectomy outcomes in patients with autoimmune cytopenias and persistent antiphospholipid antibodies.

BACKGROUND: Splenectomy is a therapy for patients with treatment-refractory autoimmune cytopenias. Antiphospholipid antibodies (aPL) can be identified in 25%-85% of these patients. In this study, we sought to identify whether the presence of aPL was associated with worse outcomes in autoimmune cytopenia's patients who had undergone splenectomy. METHODS: We conducted a retrospective cohort study of patients who underwent splenectomy from 2000 to 2018. We describe clinical characteristics and outcomes in patients with autoimmune cytopenia's diagnosis with positive determinations of aPL. Additionally, we performed a case-control sub-analysis 1:1 of the cases with autoimmune cytopenia's matched control patients with negative aPL determination. RESULTS: A splenectomy was performed in 707 patients, of which we included 34 for the analysis. The median age at the time of splenectomy was 37 years (range 19-61), 53% corresponded to immune thrombocytopenia (ITP) and 47% to autoimmune hemolytic anemia (AIHA). Compared with controls (n = 34), patients had more treatment lines in addition to steroids (p = .02). There were no differences in complete response rate, 65% in cases and 80% in controls (p = .17). However, there was numerically a higher incidence of early infections (21% of cases vs. 3% controls, p = .05). During the entire follow-up, 15% of aPL patients compared with 9% of control patients had a thrombotic event (p = .70). DISCUSSION: Splenectomy for treatment-refractory autoimmune cytopenia's patients with persistent aPL is an effective treatment despite some safety concerns related to early infections. These results suggest that the presence of aPL should not impact the decision to undergo splenectomy.

Late-Onset Hematological Toxicity (LOHT) in Patients with B-Cell Lymphomas: A Survey in 758 Cases

ABSTRACT Background: The increasing survival of patients with non-Hodgkin lymphoma has allowed the diagnosis of long-term complications, including late-onset hematological toxicity (LOHT), transitory cytopenias, or therapy-related myeloid neoplasm (t-MDS/t-AML). Objective: The objective of the study was to determine the frequency and clinical evolution of LOHT in patients with lymphoproliferative malignancies. Materials and Methods: Two cohorts of patients B-cell lymphomas were reviewed. Patients who achieved full hematologic recovery at the end of treatment, and thereafter developed any degree of cytopenia were included in the study. Clinical and biochemical parameters were compared between patients with and without cytopenias with X2 test. Bi- and multivariate analyses were performed to evaluate factors associated with the development of late-onset cytopenias. Results: Of 758 patients enrolled, 19 developed cytopenias (2.5%). Transitory cytopenia was documented in 6 cases, 3 developed ICUS, 8 t-MDS, and 2 t-AML. In patients with FL, only hemoglobin < 12 g/dL (p = 0.032) and >6 nodal areas (p = 0.037) at diagnosis were factors statistically significant for the development of cytopenia. During cytopenias, 55% of patients died. Conclusions: LOHT constitutes a cause of morbidity and mortality in 2.5% of lymphoma patients treated with different therapy regimens.

Common variable immunodeficiency-associated endotoxemia promotes early commitment to the T follicular lineage.

BACKGROUND: Although chiefly a B-lymphocyte disorder, several research groups have identified common variable immunodeficiency (CVID) subjects with numeric and/or functional TH cell alterations. The causes, interrelationships, and consequences of CVID-associated CD4+ T-cell derangements to hypogammaglobulinemia, autoantibody production, or both remain unclear. OBJECTIVE: We sought to determine how circulating CD4+ T cells are altered in CVID subjects with autoimmune cytopenias (AICs; CVID+AIC) and the causes of these derangements. METHODS: Using hypothesis-generating, high-dimensional single-cell analyses, we created comprehensive phenotypic maps of circulating CD4+ T cells. Differences between subject groups were confirmed in a large and genetically diverse cohort of CVID subjects (n = 69) by using flow cytometry, transcriptional profiling, multiplex cytokine/chemokine detection, and a suite of in vitro functional assays measuring naive T-cell differentiation, B-cell/T-cell cocultures, and regulatory T-cell suppression. RESULTS: Although CD4+ TH cell profiles from healthy donors and CVID subjects without AICs were virtually indistinguishable, T cells from CVID+AIC subjects exhibited follicular features as early as thymic egress. Follicular skewing correlated with IgA deficiency-associated endotoxemia and endotoxin-induced expression of activin A and inducible T-cell costimulator ligand. The resulting enlarged circulating follicular helper T-cell population from CVID+AIC subjects provided efficient help to receptive healthy donor B cells but not unresponsive CVID B cells. Despite this, circulating follicular helper T cells from CVID+AIC subjects exhibited aberrant transcriptional profiles and altered chemokine/cytokine receptor expression patterns that interfered with regulatory T-cell suppression assays and were associated with autoantibody production. CONCLUSIONS: Endotoxemia is associated with early commitment to the follicular T-cell lineage in IgA-deficient CVID subjects, particularly those with AICs.

Efectividad de Rituximab en el tratamiento de citopenias autoinmunes refractarias en adultos / Effectiveness of Rituximab in the treatment of cytopenias refractory autoimmune in adults

The term autoimmune cytopenias is referred to a heterogeneous group of diseases characterized by a reduced peripheral blood cell counts in one or more cellular series, because an immunological disorder. The first line therapy is steroids, followed by splenectomy or immunesupressant therapy in non-responders. Rituximab is an anti CD20 monoclonal antibody used as a third line in refractory patients or as an alternative to splenectomy. We present a retrospective study of nine patients with autoimmune cytopenias treated in a public hospital setting with rituximab. Five patients with the diagnosis of inmune thrombocytopenic purpura received it, all of them achieved hematological response (4 complete and one partial). The median time to the best response was 6 weeks, staying in this category after 6 months of follow up. Four patients with autoimmune hemolytic anemia received rituximab, three of them achieving partial response and one was lost from follow up. No severe adverse effects related to rituximab were registered.

Hematological findings and factors associated with feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) positivity in cats from southern Brazil / Achados hematológicos e fatores associados a positividade pelo vírus da leucemia felina (felv) e vírus da imunodeficiência felina em gatos do sul do Brasil

Using a retrospective study, 493 cats tested for FeLV and FIV were selected for analysis of the association between hematologic findings and positivity at immunoassay test. Individual and hematologic variables were assessed considering the influence of results using univariate and multivariate logistic regression analysis. Out 153 of the 493 cats were positive for FeLV (31%), 50 were positive for FIV (10.1%) and 22 were positive for both FIV and FeLV (4.4%). Multivariate analysis detected significant associations between FeLV infection and age below 1 year (p=0.01), age from 1 to 10 years (p=0.03), and crossbreed (p=0.04). Male cats were more likely to be FIV-positive (p=0.002). Regarding hematological changes, FeLV-positive cats have higher odds to anemia, leukopenia and lymphopenia than FeLV-negative cats. FIV-positive cats are more likely to have anemia than negative. Identification of associated factors related to animal status and correlation of hematological disorders with infection by retroviruses in cats could be useful for detecting these retroviral diseases in cats.(AU)

Através de um estudo retrospectivo, 493 gatos testados para FeLV e FIV foram selecionados para análise da associação entre as alterações hematológicas e a positividade no teste imunoenzimático. Variáveis individuais e hematológicas foram consideradas para verificar a influência dos resultados utilizando análise de regressão logística univariada e multivariada. Um total de 153 de 493 gatos avaliados foram positivos para o FeLV (31%), 50 foram positivos para o FIV (10,1%) e 22 foram positivos para FIV e FeLV (4,4%). Análise multivariada detectou uma associação significativa entre a infecção pelo FeLV e a idade abaixo de 1 ano (P=0,01), idade entre 1 a 10 anos (P=0,03) e raça mista (P=0,04). Gatos machos foram mais predispostos a serem positivos para FIV (P=0,002). Com base nas alterações hematológicas, gatos positivos para o FeLV tem maior odds para apresentar anemia, leucopenia e linfopenia que os negativos. Gatos positivos para FIV possuem maiores chances de apresentarem anemia que os gatos negativos. A identificação dos fatores associados à infecção relacionados ao perfil do animal e a correlação com os distúrbios hematológicos com a infecção, pode ser útil para detecção das doenças retrovirais em gatos.(AU)

Hematological findings and factors associated with feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) positivity in cats from southern Brazil / Achados hematológicos e fatores associados a positividade pelo vírus da leucemia felina (felv) e vírus da imunodeficiência felina em gatos do sul do Brasil

Using a retrospective study, 493 cats tested for FeLV and FIV were selected for analysis of the association between hematologic findings and positivity at immunoassay test. Individual and hematologic variables were assessed considering the influence of results using univariate and multivariate logistic regression analysis. Out 153 of the 493 cats were positive for FeLV (31%), 50 were positive for FIV (10.1%) and 22 were positive for both FIV and FeLV (4.4%). Multivariate analysis detected significant associations between FeLV infection and age below 1 year (p=0.01), age from 1 to 10 years (p=0.03), and crossbreed (p=0.04). Male cats were more likely to be FIV-positive (p=0.002). Regarding hematological changes, FeLV-positive cats have higher odds to anemia, leukopenia and lymphopenia than FeLV-negative cats. FIV-positive cats are more likely to have anemia than negative. Identification of associated factors related to animal status and correlation of hematological disorders with infection by retroviruses in cats could be useful for detecting these retroviral diseases in cats.(AU)

Através de um estudo retrospectivo, 493 gatos testados para FeLV e FIV foram selecionados para análise da associação entre as alterações hematológicas e a positividade no teste imunoenzimático. Variáveis individuais e hematológicas foram consideradas para verificar a influência dos resultados utilizando análise de regressão logística univariada e multivariada. Um total de 153 de 493 gatos avaliados foram positivos para o FeLV (31%), 50 foram positivos para o FIV (10,1%) e 22 foram positivos para FIV e FeLV (4,4%). Análise multivariada detectou uma associação significativa entre a infecção pelo FeLV e a idade abaixo de 1 ano (P=0,01), idade entre 1 a 10 anos (P=0,03) e raça mista (P=0,04). Gatos machos foram mais predispostos a serem positivos para FIV (P=0,002). Com base nas alterações hematológicas, gatos positivos para o FeLV tem maior odds para apresentar anemia, leucopenia e linfopenia que os negativos. Gatos positivos para FIV possuem maiores chances de apresentarem anemia que os gatos negativos. A identificação dos fatores associados à infecção relacionados ao perfil do animal e a correlação com os distúrbios hematológicos com a infecção, pode ser útil para detecção das doenças retrovirais em gatos.(AU)

Citopenias hematológicas en enfermedades autoinmunes sistémicas / Blood cytopenias in systemic autoimmune conditions

Las citopenias hematológicas son un hallazgo frecuente y potencialmente grave en las Enfermedades Autoinmunes Sistémicas. Sus causas pueden ser muy variadas, de ahí la importancia de un abordaje diagnóstico sistematizado que asegure además el tratamiento correcto. En este artículo se revisan las generalidades de las citopenias hematológicas en cuanto a frecuencia, causas, así como su enfoque diagnóstico y terapéutico.

The hematologic cytopenias are a frequent and potentially dangerous finding in the Systemic Autoimmune Diseases. It may have different etiologies, and for that reason it is important a systematic approach to ensure the correct diagnosis and treatment. In this article, the frequency, etiology, diagnostic approach and treatment of the hematologic cytopenias are reviewed.

Autoimmune manifestations in SCID due to IL7R mutations: Omenn syndrome and cytopenias.

B+NK+SCID (severe combined immunodeficiency) due to IL7Rα deficiency represents approximately 10% of American SCID cases. To better understand the spectrum of autoimmune disorders associated with IL7Rα deficiency, we describe two unrelated IL7Rα-deficient female SCID infants whose clinical picture was dominated by autoimmune manifestations: one with intrauterine Omenn syndrome (OS) and another with persistent thrombocytopenic purpura since 4months of age. The OS baby harbored a homozygous p.C118Y mutation in IL7R. She presented dense eosinophilic infiltrates in several organs, including pancarditis, which may have contributed to her death (on the 2nd day of life). B cells were observed in lymph nodes, spleen, bone marrow and thymus. The second patient harbored compound heterozygous p.C118Y and p.I121NfsX8 mutations. She underwent a successful unrelated cord blood transplant. In conclusion, early OS can be observed in patients with IL7R mutations, and autoimmune cytopenias could also complicate the clinical course of SCID babies with this type of defect.