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New articles posted here - update 6-28-17
- Sandi
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- Sandi Forum Moderator Diagnosed in 1998, currently in remission. Diagnosed with Lupus in 2006. Last Count - 344k - 6-9-18
Results showed TAC was significantly lower in newly diagnosed ITP patients compared to chronic ITP patients. Both groups showed lower levels than the healthy controls. At the end of the study both BS and PC improved a great deal in patients who received antioxidant compared to placebo. Researchers concluded there were reduced antioxidant mechanisms in ITP patients. Antioxidant therapy reduced the oxidative stress in both the newly diagnosed and chronic ITP patients. Some well-known antioxidants include Vitamins A, C, and E. Eating an anti-inflammatory diet also helps reduce oxidative stress.
Elalfy MS, Elhenaway YI, Deifalla S, et al. “Oxidant/antioxidant status in children and adolescents with immune thrombocytopenia (ITP) and the role of an adjuvant antioxidant therapy.” Pediatr Blood Cancer 2015, Feb 7: doi: 10.1002/pbc.25434 [Epub ahead of print]
www.ncbi.nlm.nih.gov/pubmed/25663642
informahealthcare.com/doi/abs/10.3109/09537104.2011.610909
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- Sandi
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- Sandi Forum Moderator Diagnosed in 1998, currently in remission. Diagnosed with Lupus in 2006. Last Count - 344k - 6-9-18
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See more....
www.bloodjournal.org/content/125/11/1690?sso-checked=true
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- Sandi
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Abstract
Primary immune thrombocytopenia (ITP) in adults often assumes a chronic course that requires persistent monitoring and treatment. Medical therapy has traditionally been viewed as a means of temporarily raising the platelet count with little or no potential to induce long-term platelet responses off treatment. However, several recent studies have tested the hypothesis that intensive medical therapy administered early in the disease course may ameliorate or even cure ITP. In this review, we propose a biological rationale for medical intervention that simultaneously targets the innate and adaptive immune responses administered early in the course of disease. We also critically examine data on long-term outcomes after single-agent and multi-agent medical therapy. Intensive regimens that target inflammation and adaptive immunity (e.g., combination high-dose dexamethasone and rituximab) appear to improve response rates at 6 to 12 months compared with standard first-line therapy (e.g., prednisone, high-dose dexamethasone alone) in newly diagnosed patients. Controlled trials with extended follow-up are needed to determine whether these intensive regimens induce more cures compared with standard treatment or merely delay relapse at the expense of potentially greater toxicity.
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
www.ncbi.nlm.nih.gov/pubmed/25793364
*One person on the FB page used the combo and had a six year remission.
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- Rob16
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Long term controlled studies are certainly called for if the results of the following study hold up to further scrutiny.
50% of patients receiving a remission of 5 years (or more) is pretty impressive.
www.bloodjournal.org/content/122/21/2310
Rituximab Combined With Three Cycles Of High Dose Dexamethasone Provides a Long Term Response Rate Similar To That Of Splenectomy In Patients With Immune Thrombocytopenia (ITP) Of Duration Less Than 2 Years
Methods
Combination of standard-dose rituximab (weekly x 4) and usually 3 4-day cycles of 28mg/m2 (max. 40mg) dex at 2-week intervals (R+3Dex) was explored in 67 pediatric and adult pts with ITP at WCMC. ...
Conclusions
R+3Dex provides clearly superior results to rituximab alone. Notably, there was a 75% response rate overall (50/67 pts) compared to 50% with R alone. The 5 year response rate was almost 50% of all patients and 3/5 of responders. In patients who had had ITP for ≤ 2 years, the response is comparable to what has been reported with splenectomy...
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- mrsb04
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- ITP since 2014. Retired nurse. My belief is empower patients to be involved as much as possible in their care. Read, read, read & ALWAYS question medics about the evidence base they use.
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- Sandi
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- mrsb04
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- Sandi
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Some toxicities do not show up for years or are cumulative. Both of those (Rituxan and Dex) are potent treatments that have risks. If I knew it would cure me, I'd go for it. But if I knew that it might not, I would not want to try that first.
Reactions/side effects to drugs do occur and some are not temporary. If you end up with one or more, it's already too late.
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- mrsb04
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- mac
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- Sandi
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- Sandi Forum Moderator Diagnosed in 1998, currently in remission. Diagnosed with Lupus in 2006. Last Count - 344k - 6-9-18
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Mac - there is no set order for treatments, but yes, it is common to try Rituxan after Prednisone.
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- EmilyK
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- Diagnosed jan 2015 at age 50 with 13,000 platelets.
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- Rob16
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I know there were some studies a while back showing that Rituxan with high dose dexamethasone was more effective than HD-DXM alone, but I don't remember by how much, and I don't remember that the HD-DXM was done in multiple pulses.
The data from the following two studies may be comparing apples to oranges, especially regarding duration of response. Still, these studies seem to show that multiple pulses of HD-DXM may be nearly as good as the combination of Rituxan with multiple pulses of HD-DXM.
If this is correct, then it might be more prudent to try the treatments sequentially rather than combined. And if the first treatment works forego the second treatment along with the added risk.
I hope these issues will be taken into account when designing future studies.
www.bloodjournal.org/content/122/21/2310
Rituximab Combined With Three Cycles Of High Dose Dexamethasone Provides a Long Term Response Rate Similar To That Of Splenectomy In Patients With Immune Thrombocytopenia (ITP) Of Duration Less Than 2 Years
www.bloodjournal.org/content/109/4/1401
Therapy with high-dose dexamethasone (HD-DXM) in previously untreated patients affected by idiopathic thrombocytopenic purpura: a GIMEMA experience
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- Sandi
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Abstract
OBJECTIVE:
To determine the efficacy and safety of oral caffeic acid (CA) tablet in management of primary immune thrombocytopenia(ITP).
METHODS:
One hundred and three ITP patients with PLT>10×10⁹/L and no serious bleeding symptoms from three centers were enrolled. According to their platelet count before CA treatment, these patients were divided into group A (PLT<30×10⁹/L), including 24 females and 27 males with median age 48(18-84)years; and group B (PLT≥30×10⁹/L), including 33 females and 19 males with median age 43(18-83)years. Patients in both groups took CA tablets orally of 300 mg three times per day for 12 consecutive weeks. Combined medicine treatment such as corticosteroids, danazol, TPO and Rituximab, which might increase the platelet count of these patients, were not allowed during CA therapy.
RESULTS:
In group A, the overall response rate was 51.0%(26/51), with 2 patients achieving complete response (CR) and 24 patients achieving response(R). Of 26 patients achieving response (CR+R), the median platelet count before CA therapy was 20.5(15-28)×10⁹/L , and the median peak platelet count after CA therapy was 63(38-112)×10⁹/L. The median time to achieving response was 4(2-10) weeks. Patients with pretreatment PLT>20×10⁹/L showed significantly better response than those PLT<20×10⁹/L (68.0% vs 34.6%, P=0.017). In group B, the CR rate was 40.4%(21/52). Frequency of CA-related adverse events was 1.94%(2/103), including mild nausea in 1 case and elevation of liver enzymes in 1 case. Both were grade 1 and transient.
CONCLUSION:
Caffeic acid was effective in patients with ITP with few and mild adverse effects.
www.ncbi.nlm.nih.gov/pubmed/25778883
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- Ann
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- mrsb04
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- Rob16
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en.wikipedia.org/wiki/Caffeic_acid
Edit:
"Even though caffeic acid can be found in coffee, it is unrelated to caffeine."
www.wisegeek.com/what-is-caffeic-acid.htm
Edited to provide Sandi a more reliable source.
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- Sandi
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- meredithjane
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Thanks for all the time & effort Sandi & Rob.
mj
PS Sounds like a Mediterranean diet is the go with herbs, cinnamon, red wine etc.
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- mrsb04
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(Caffeic acid) "It is also found in barley grain and in rye grain." WIKI
That's all I needed to know.....it's in my beer.
.
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- Ann
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- Sandi
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- Sandi Forum Moderator Diagnosed in 1998, currently in remission. Diagnosed with Lupus in 2006. Last Count - 344k - 6-9-18
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See more....
www.businesswire.com/news/home/20150331005154/en/Protalex-Announces-FDA-Acceptance-Investigational-Drug-Application#.VTfOCpOacSV
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- Sandi
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- Sandi Forum Moderator Diagnosed in 1998, currently in remission. Diagnosed with Lupus in 2006. Last Count - 344k - 6-9-18
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BACKGROUND:
Mental stress and daily crises comprise a part of physical and mental threats. Perceived stress is a physical and mental threat, as well. Perceived stress is a psychological process during which the individual considers his/ her physical and psychological welfare as being threatened. Since idiopathic thrombocytopenic purpura (ITP) is one of the chronic diseases being able to affect patients' perceived stress, this study was conducted to compare perceived stress in ITP patients and healthy people.
MATERIALS AND METHODS:
This is a descriptive-comparative study with control and case groups. In this study, 64 ITP patients referring Seyed Al-Shohada Hospital and the same number of healthy individuals from the patients' neighborhood, as the control group, were selected randomly and compared. The Kohen Perceived Stress Standard Questionnaire was used to collect the data. The data were analyzed by SPSS and Student's independent t-test, chi-square, and Mann-Whitney test. Results : 64.1%, 59.4% and 53.1% of participants in case group were older than 35 years old, female and had elementary education. 78.1% of case group had severe perceived stress. 70.3% of participants in control group experienced mild perceived stress. Mann-Whitney test showed significant difference between two groups in level of stress (p<0.001).
CONCLUSION:
In ITP patients, perceived stress was considerable. Planning interventional measures to determine stress-making agents and subside or at least control them is very essential.
www.ncbi.nlm.nih.gov/pubmed/25922646
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- Sandi
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www.bloodjournal.org/content/early/2015/05/13/blood-2015-03-631937?sso-checked=true
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- Rob16
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HOWEVER: the triple study was done on "chronic" ITP patients whereas one of the other studies was done on "newly diagnosed" patients, and the other was done on a mixed group of patients, some up to to 2 years diagnosed and others longer. This makes a huge difference. Nonetheless, here are the comparisons, for what it's worth:
The 4 weeks standard dose Rituxan + 3 cycles X 4 days HD-DXM of the earlier study shown below gives better relapse free survival rates at 60 months than this triple therapy study of 4 weeks Low dose Rituxan + 1 cycle HD-DXM + 28 days cyclosporine at 24 months.
www.bloodjournal.org/content/122/21/2310
[Standard dose] Rituximab Combined With Three Cycles Of High Dose Dexamethasone Provides a Long Term Response Rate Similar To That Of Splenectomy In Patients With Immune Thrombocytopenia (ITP) Of Duration Less Than 2 Years
The study also claims a 60% 6 month response rate (does that mean CR? or CR+PR?), while an earlier study of 4 weeks low-dose (100 mg) Rituxan + 1 cycle x 4 days HD-DXM claims a 76.2% 6 month sustained response rate. So the triple therapy with cyclosporine APPEARS to have fared less well than the Gómez-Almaguer study.
The fact that the triple therapy got such good results with CHRONIC ITP patients is extremely promising.High response rate to low‐dose rituximab plus high‐dose dexamethasone as frontline therapy in adult patients with primary immune thrombocytopenia
David Gómez-Almaguer, et al First published: 2 April 2013
N=21 Complete sustained response at 6 month 76.2%
onlinelibrary.wiley.com/enhanced/doi/10.1111/ejh.12102/#author1
www5.medicine.wisc.edu/~williams/ld_ritux_dex_itp.pdf
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- Sandi
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Rob16 wrote: Two earlier studies of Rituxan + HD-DXM APPEAR to show better results than the triple therapy study does here.
HOWEVER: the triple study was done on "chronic" ITP patients whereas one of the other studies was done on "newly diagnosed" patients, and the other was done on a mixed group of patients, some up to to 2 years diagnosed and others longer. This makes a huge difference.
Yes, that would make a big difference.
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- Sandi
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Persistent or chronic immune thrombocytopenias (P/C-ITP) are acquired blood disorders lasting more than 3 months or 1 year, respectively. The pathogenesis of these disorders is thought to be immunological. We hypothesized that some patients with P/C-ITP might have an intrinsic megakaryopoiesis defect. We identified a group of P/C-ITP patients with acquired isolated mild thrombocytopenia (30-100 × 109 /l), undetectable anti-platelet antibodies, negative autoimmune investigations and no need for treatment. We examined in vitro megakaryocyte differentiation and compared these patients' results with those of acute-ITP patients and healthy controls. No difference in proliferation, ploidy or expression of surface markers was found. In contrast, P/C-ITP patients had significantly fewer proplatelet-forming megakaryocytes. This novel observation demonstrated that some patients diagnosed with P/C-ITP have an intrinsic megakaryopoiesis defect independent of the bone-marrow environment. Further investigations are needed to dissect mechanisms underlying this impaired proplatelet formation in these patients.
© 2015 John Wiley & Sons Ltd.
www.ncbi.nlm.nih.gov/pubmed/25873418
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- Sandi
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www.ncbi.nlm.nih.gov/pubmed/25949982
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