Eltrombopag治疗慢性淋巴细胞白血病难治性免疫性血小板减少1例报告。

IF 0.7 Q3 MEDICINE, GENERAL & INTERNAL
International Medical Case Reports Journal Pub Date : 2025-10-09 eCollection Date: 2025-01-01 DOI:10.2147/IMCRJ.S555045
Mortadah Alsalman
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引用次数: 0

摘要

简介:我们报告一例慢性淋巴细胞白血病相关的免疫性血小板减少症(cll相关的ITP)与次优反应类固醇响应二线药物。病例介绍:一名68岁女性糖尿病合并慢性淋巴细胞白血病(CLL)患者,其身体和右眼周围出现自发性瘀伤。初步实验室检查显示血红蛋白水平10.6 g/dL,血小板计数11 × 109/L,白细胞计数50.0 × 109/L,直接和间接Coombs试验均为阴性。一旦泼尼松逐渐减少,患者反应不佳,血小板迅速下降。因此,以每日50mg的剂量引入Eltrombopag,在两年多的时间里产生了快速和持续的反应,血小板计数达到282 × 109/L而无需抢救治疗。值得注意的是,在使用依曲巴的前三周内,类固醇逐渐减少,当血小板计数达到50 × 109/L时,恢复使用阿司匹林。结论:对于慢性淋巴细胞白血病相关ITP患者,尤其是那些诊断为糖尿病的患者,依曲巴是一种有效且安全的治疗选择。然而,在开始治疗前、剂量增加期间或过渡到替代治疗时,铁缺乏和依曲巴的食物相互作用的潜在风险是重要的考虑因素。未来需要大量样本量的研究以及细胞遗传学和分子异常的鉴定,以确定可能对Eltrombopag有良好反应的患者群体,而不需要挽救治疗、化疗、免疫治疗或CLL定向治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Eltrombopag for Refractory Immune Thrombocytopenia in a Patient with Chronic Lymphocytic Leukemia: A Case Report.

Introduction: We report a case of chronic lymphocytic leukemia associated immune thrombocytopenia (CLL-associated ITP) with suboptimal response to steroid responding to second line agent.

Case presentation: A 68-year-old female patient known to have diabetes mellitus and chronic lymphocytic leukemia (CLL) presented with spontaneous bruising on her body and around her right eye. Initial laboratory investigations reveal hemoglobin level of 10.6 g/dL, platelet count of 11 × 109/L, white blood cell count of 50.0 × 109/L with negative direct and indirect Coombs tests were negative. The patient has a suboptimal response and rapid platelet declines once prednisone is tapered off. Consequently, Eltrombopag was introduced at a daily dosage of 50 mg, resulting in a rapid and sustained response over two years, reaching a platelet count of 282 × 109/L without requiring rescue treatment. Notably, steroids were tapered within the first three weeks of Eltrombopag administration, and aspirin was resumed once the platelet count reached 50 × 109/L.

Conclusion: Eltrombopag represents an effective and safe treatment alternative for patients with CLL-associated ITP, particularly those diagnosed with diabetes mellitus. However, the potential risks of iron deficiency and Eltrombopag's food interactions prior to initiating therapy, during dose escalations, or when transitioning to alternative treatments are important considerations. Future studies with large number sample size along with identification of cytogenetic and molecular abnormalities are required to identify patient populations that may respond favorably to Eltrombopag without necessitating rescue therapies, chemotherapy, immunotherapy or CLL directed therapy.

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来源期刊
International Medical Case Reports Journal
International Medical Case Reports Journal MEDICINE, GENERAL & INTERNAL-
CiteScore
1.40
自引率
0.00%
发文量
135
审稿时长
16 weeks
期刊介绍: International Medical Case Reports Journal is an international, peer-reviewed, open access, online journal publishing original case reports from all medical specialties. Submissions should not normally exceed 3,000 words or 4 published pages including figures, diagrams and references. As of 1st April 2019, the International Medical Case Reports Journal will no longer consider meta-analyses for publication.
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