Platelet E-News – December 16, 2003

Contents:

The American Society of Hematology (ASH) 45th Annual Meeting and Exposition was held December 6 – 9, 2003 in San Diego. In addition to days filled with scientific education sessions, there were thousands of posters, hundreds of exhibits, and separate meetings of groups with like interests.

This version of the e-news is devoted to a few of the highlights from the ASH meeting. There is just too much to report in this venue. We will publish additional information in subsequent e-news. The Spring issue of The Platelet News, our quarterly newsletter, will feature a full-length article on the ASH meeting. See www.pdsa.org/joinus.htm to become a member and receive your copy.

You can read the ASH meeting abstracts, view a few of the presentations, and read articles from the ASH daily newspaper on the ASH web site, http://www.hematology.org

Articles:

  • Report from the EHA Working Group
  • Mycophenolate-mofetil in ITP therapy
  • Platelet Growth Factor – Initial Results
  • Platelet Counting in Severe Thrombocytopenia
  • Update on H-Pylori
  • Outcome of ITP Patients Refractory to Splenectomy

 

REPORT FROM THE EHA WORKING GROUP

The European Haematology Association (EHA) has established a working group on thrombocytopenias. The aim of the working group is to standardize and coordinate research projects worldwide. A central research focus will help reduce redundancy and facilitate comparison of research results. One of the working group’s first projects will be to standardize reporting terminology such as ‘complete response’ and ‘chronic’. Other projects include an ITP registry and genomic studies.

See: http://www.hemato.ven.it/EHAWG/home.htm

At our San Diego regional meeting, Dr. Drew Provan, co-chair of the EHA working group, discussed the EHA committee projects and other recent ITP research. We have an audio tape of the meeting. If you would like a copy of Dr. Provan’s presentation at our regional meeting send a $12.00 check and note to PDSA, P.O. Box 61533, Potomac, MD 20859. We thank Nabi for supporting our regional meetings.

MYCOPHENOLATE-MOFETIL IN ITP THERAPY

Mycophenolate-mofetil (Cellcept ®), a drug used to prevent rejection in kidney and heart transplant patients, is sometimes used to treat ITP. Dr. Drew Provan described a study done by Hou Peng and associates and reported in the European Journal of Haematology. In this study, mycophenolate-mofetil was given to 21 refractory ITP patients. Sixty-two percent of these patients had some response to the treatment including 24% who had a complete response. The response to this treatment is slow and can take a few months. It is unclear what will happen when the medication is discontinued or the long term effects of taking this treatment.

http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601081.html

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12756016&dopt=Abstract

PLATELET GROWTH FACTOR – INITIAL RESULTS

James Bussel, MD, reported on the results of a platelet growth factor (AMG531), an ITP therapy in the very early phase of testing. As in all new treatments, AMG531 was initially given to a few patients during a controlled clinical trial to assess the safety of the treatment. The results of this initial trial demonstrated that AMG531 was well-tolerated at a dose that maintained the platelet count in a normal range. Because of the positive data, a larger clinical trail is being planned.

PLATELET COUNTING IN SEVERE THROMBOCYTOPENIA

The platelet count results from the same blood sample can vary widely, depending on the brand of machine used to analyze the sample and the time lag between taking the sample and its analysis. According to Sam Machin, MD, a consultant to several blood analysis machine manufacturers, the algorithms used to differentiate a platelet from other cells in the blood differ between manufacturers. Therefore, the same blood sample analyzed by different machines can produce very different results. Lab conditions can also cause variations in platelet count since platelets swell as they absorb the anti-coagulant mixture in the test tubes. These variations are particularly noticeable in platelet counts below 30,000.

UPDATE ON H-PYLORI

In the corporate Friday program, “The Fifth Annual Review of Immune Thrombocytopenic Purpura, James Bussel, MD, during his talk on “ITP: New Developments in Diagnosis and Clinical Management” updated the audience on several studies on the eradication of H-Pylori in ITP patients. The results of the studies continue to be mixed in that some of them report a positive response in platelet count when H-Pylori positive ITP patients are treated to eliminate H-Pylori and others show no response at all in platelet count. He and others are planning a large scale trial to determine the factors that may be responsible for the variations in results. He also emphasized the desirability of using a breath test in determining if someone is infected with H-Pylori.

Other topics presented during “The “Fifth Annual Review…” are the pathophysiology of ITP and three case presentations on childhood ITP, pregnancy, and refractory ITP. This session was sponsored by Nabi pharmaceuticals. Nabi has donated copies of the handouts from the meeting. This is a 64 page booklet that contains a summary of the presentation and copies of the slides. If you would like a copy of the booklet, please send a note and a check for $7.00 to cover postage and handling to PDSA, P.O. Box 61533, Potomac, MD 20859.

OUTCOME OF PATIENTS REFRACTORY TO SPLENECTOMY

There have been many studies evaluating the effectiveness of splenectomy. The study reported by Dr. Robert McMillan is the first large scale study to look at the outcome of patients whose platelet count relapsed after splenectomy. In his study, the records of 105 patients who failed splenectomy were reported. Seventy-five patients eventually attained a stable platelet count of over 50,000. Fifty-one patients maintained their remission after stopping all therapy, while 24 patients required continued treatment. Of those studied, 36% had additional autoimmune diseases and/or had a high incidence of venous thrombosis. Nine patients developed disorders, possibly associated with ITP, years after their diagnosis.

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