Jesús Hernández-Reyes

Eltrombopag and high-dose dexamethasone as frontline treatment of newly diagnosed immune thrombocytopenia in adults

Immune thrombocytopenia (ITP) results from platelet destruction and production suppression. Eltrombopag belongs to a new class of thrombopoietin-mimetic drugs that raise platelet counts in ITP patients. We performed a single-arm study to assess the response to a single course of dexamethasone (40 mg by mouth, days 1-4) in combination with eltrombopag (50 mg, days 5-32) in 12 adults with newly diagnosed ITP in an outpatient setting. Median follow-up was 12.5 months. After therapy (day 33), 100% of patients achieved at least ≥30 × 10(9)/L platelets. Four patients relapsed. Complete response at 6 months (platelets ≥100 × 10(9)/L) was achieved in 50% of patients and response at 6 months (platelets ≥30 <100 × 10(9)/L) was achieved in another 25%; relapse-free survival was 66.7% at 12 months (median response duration of 8.3 months). In conclusion, eltrombopag/dexamethasone is a feasible frontline therapy for ITP. This trial is registered at www.clinicaltrials.gov as NCT01652599.

Nonalcoholic Fatty Liver Disease May Cause Thrombocytopenia

/l) were prospectively studied. Pa-tients with immune thrombocytopenia [7] , overt viral hepatitis or liver cirrhosis were excluded. The study was approved by the Ethics Committee of the Clinica Ruiz and informed consent was obtained from the patients in-cluded in both groups. Alpha 2 macroglobulin, haptoglo-bin, apolipoprotein A, bilirubin, gamma-glutamyl trans-peptidase, alanine aminotransferase, aspartate amino-transferase, glucose, cholesterol and triglycerides were measured in all patients. These biochemical markers were then analyzed. FibroTest was used for the quantitative as-sessment of fibrosis, SteatoTest for the quantitative as-sessment of steatosis, ActiTest for the quantitative assess-ment of necroinflammatory activity in chronic viral hep-atitis and NashTest for the categorical diagnosis of nonalcoholic steatohepatitis [5] . Patients with a score of >50% in either the SteatoTest or the NashTest coupled with a score of <50% in the FibroTest were defined as hav-ing NAFLD. Within the group of 93 consecutive patients studied due to their platelet count <100 × 10

Primary Thrombophilia in México X A Prospective Study of the Treatment of the Sticky Platelet Syndrome

Introduction: The sticky platelet syndrome (SPS) is a common cause of thrombosis. There are no prospective studies concerning treatment. Objective: To analyze changes in platelet hyperaggregability of patients with SPS who were given antiplatelet drugs and to assess its association with rethrombosis. Methods: A total of 55 patients with a history of thrombosis and SPS phenotype were prospectively studied before and after treatment with aspirin and/or clopidogrel. Results: Patients were followed for 1 to 129 months, median 13. Of 55 patients, 40 received aspirin, 13 received aspirin + clopidogrel, and 2 received only clopidogrel. The platelet aggregation response to adenosine diphosphate and epinephrine significantly diminished after treatment, and only 2 patients developed rethrombosis 52 and 129 months after starting therapy, with the freedom from rethrombosis rate of the patients being 96.4% at 129 months. Conclusion: Using antiplatelet drugs, the platelet hyperreactivity of patients with the SPS phenotype was reverted; and this translated into a substantial decrease in the rethrombosis rate.

Oral versus Intravenous Fludarabine as Part of a Reduced-Intensity Conditioning for Allogeneic Stem Cell Transplantation

Background: In 2003, oral fludarabine was introduced in the USA for the treatment of patients with hematologic malignancies as an alternative to its intravenous (i.v.) formulation; in 2008, it was introduced in México while the i.v. formulation was withdrawn. Accordingly, i.v. fludarabine had to be replaced by oral fludarabine as part of the conditioning regimen employed to conduct allogeneic stem cell transplantation in México. Methods: Nonrandomized retrospective analysis of 55 patients conditioned with oral fludarabine compared with 113 patients conditioned with the i.v. formulation. In addition to fludarabine, the conditioning regimen included oral busulfan and i.v. cyclophosphamide. Donors were HLA-matched siblings. Results: The clinical features of the two groups were comparable. There were no statistical differences in time to neutrophil engraftment, time to platelet engraftment, acute graft versus host disease rate and nonrelapse mortality at day 100. The overall survival of patients allografted with oral fludarabine was better than those allografted with i.v. fludarabine: 62 and 33% at 67 months, respectively (p = 0.0006). Discussion: Oral fludarabine can replace its i.v. formulation as part of reduced-intensity conditioning regimens with no deleterious effect on any of the early transplantation outcomes.