This e-newsletter is a monthly publication of the Platelet Disorder Support Association. The information in this newsletter is for educational purposes only. For advice on your unique medical condition, please consult a health care professional.
Contents:
ITP and Platelet Disorders Research and Treatments
- Oxidative Stress Linked to ITP in Adults
- More Viruses Found in ITP Patients
- ITP in Children: New Research
- Rituximab plus Dexamethasone: Potent Combination
Hospitals, Insurance, and Medical Care
General Health and Medicine
ITP and Platelet Disorders Research and Treatments
Oxidative Stress Linked to ITP in Adults
Oxidative stress, the over-production of free radicals, is associated with many disease states, including ITP. In one study, newly diagnosed people with ITP had ten times the amount of vanin-1 protein (an indicator of oxidative stress), and those with chronic, non-responsive disease had three times the amount, compared to healthy controls. In another study, people with ITP had an increase in the blood proteins that signal oxidative stress and a decrease in the proteins that mitigate oxidative stress. In both studies, the authors conclude that oxidative stress may play a role in ITP and dealing with it may have therapeutic benefits.
Note: Diet, exercise, and relaxation techniques can reduce oxidative stress. See:
http://www.pdsa.org/treatments/complementary.html
Elsalakawy WA et al. “Value of vanin-1 assessment in adult patients with primary immune thrombocytopenia.” Platelets. 2013 Mar 27.
http://www.ncbi.nlm.nih.gov/pubmed/23534352
Jin CQ et al. “Antioxidant status and oxidative stress in patients with chronic ITP.” Scand J Immunol. 2013 Mar 30.
http://www.ncbi.nlm.nih.gov/pubmed/23551069
More Viruses Found in ITP Patients
Epstein-Barr virus (EBV, a type of herpes virus linked to mononucleosis) and cytomegalovirus (CMV, another type of herpes virus) have been associated with the development of ITP. These viruses were evident in about 20% of the spleens of the 40 people with ITP studied, versus only one of 20 in the control group. Those with ITP whose spleens contained the Epstein-Barr virus had a reduced platelet count compared to those with ITP who were not exposed to this virus. There was no difference in the platelet counts for the ITP patients if they did or didn’t have CMV antibodies.
Note: The “International consensus report on the investigation and management of primary immune thrombocytopenia.” suggests that testing ITP patients for the presence of CMV can have some benefit.
http://bloodjournal.hematologylibrary.org/content/115/2/168.full
For information on how viruses can cause ITP see:
http://www.pdsa.org/about-itp/causes.html
Wu Z et al. “The role of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) in immune thrombocytopenia.” Hematology. 2013 Mar 22.
http://www.ncbi.nlm.nih.gov/pubmed/23540727
ITP in Children: New Research
Pediatric hematologists from around the world have submitted data on their treatment of children with ITP to the Intercontinental Cooperative ITP Study Group (ICIS). With disease history for 1,345 children, it is the largest database of its kind in existence. A recent summary of the data states: “Remission was observed in 37% of patients between 28 days and 6 months, 16% between 6 and 12 months, and 24% between 12 and 24 months. There were no reports of intracranial hemorrhage, and the most common site of bleeding was skin.” Increased drug treatment was associated with an increased number of bleeding sites.
In a study of hospital records in the US from 2008 to 2010, researchers found 2,314 children (age 1 – 18) admitted with a new diagnosis of ITP. Although guidelines recommend a conservative and mostly watchful waiting approach to children with ITP, 90% of the children in this hospital study received a treatment, usually IVIg. There was considerable geographic variation in treatment strategies, length of stay, charges, and readmission rates.
Neunert CE et al. “Bleeding manifestations and management of children with persistent and chronic immune thrombocytopenia: data from the Intercontinental Cooperative ITP Study Group (ICIS).” Blood. 2013 Apr 2.
http://bloodjournal.hematologylibrary.org/content/early/2013/04/02/blood-2012-12-466375.abstract
Kime C et al. “Patterns of Inpatient Care for Newly Diagnosed Immune Thrombocytopenia in US Children's Hospitals.” Pediatrics. 2013 Apr 8.
http://pediatrics.aappublications.org/content/early/2013/04/03/peds.2012-2021.abstract
Rituximab plus Dexamethasone: Potent Combination
We first mentioned the success of this combination in our January 2013 e-news when the study results were available on-line. Since the paper has been in print, this therapeutic approach has gained traction with articles in other venues and with more published research. In short, it has people talking. In this study published in Blood, the rituximab (Rituxan®) plus dexamethasone group had a better response (and a greater number of side effects) than the dexamethasone-only group. But what sets this study of newly diagnosed ITP patients apart is that it was a randomized controlled trial comparing two treatments for ITP with a relatively long follow-up period.
The Blood study used the lymphoma dose of rituximab. Another study, looking at prior patient experience, showed that using a lower dose of rituximab plus dexamethasone was more effective than prednisone for newly diagnosed patients.
Rao VK. “ITP: hematology's Cosette from Les Miserables.” Blood. 2013 Mar 14;121(11):1928-30
http://bloodjournal.hematologylibrary.org/content/121/11/1928.long
”Rituximab improved dexamethasone response rates in immune thrombocytopenia.” Healio Hematology/Oncology April 4, 2013.
http://www.healio.com/hematology-oncology/hematology/news/online/%7Bd1c2680d-b565-45f3-b173-0d40fd8be316%7D/rituximab-improved-dexamethasone-response-rates-in-immune-thrombocytopenia
Gudbrandsdottir S et al. “Rituximab and dexamethasone vs dexamethasone monotherapy in newly diagnosed patients with primary immune thrombocytopenia.” Blood. 2013 Mar 14;121(11):1976-81.
http://www.ncbi.nlm.nih.gov/pubmed/23293082
Gómez-Almaguer D et al. “High response rate to low-dose rituximab plus high-dose dexamethasone as frontline therapy in adult patients with primary immune thrombocytopenia.” Eur J Haematol. 2013 Mar 7.
http://www.ncbi.nlm.nih.gov/pubmed/23470153
Hospitals, Insurance, and Medical Care
Pharma Sales Reps Provide Incomplete Info
Selected physicians in Canada, France, and the US participated in a survey to assess the quality of information they received from consecutive visits by pharmaceutical sales representatives. The pharmaceutical reps mentioned adverse events in about 5% of drug promotions, although 45% of these drugs had black box warnings, a sign that the FDA considered them to have significant potential problems. More harm information was mentioned in France, a country that has stricter laws regarding pharmaceutical promotion. Despite the lack of information, doctors said they were ready to prescribe the treatments 64% of the time. This research questions “whether current approaches to regulation of sales representatives adequately protect patient health.”
Mintzes B et al. “Pharmaceutical Sales Representatives and Patient Safety: A Comparative Prospective Study of Information Quality in Canada, France and the United States.” J Gen Intern Med. 2013 Apr 5.
http://www.ncbi.nlm.nih.gov/pubmed/23558775, http://link.springer.com/article/10.1007/s11606-013-2411-7
Healthcare Privacy Often Misinterpreted
The Health Insurance Portability and Accountability Act (HIPAA), enacted in 1996, is sometimes used to prevent family members from receiving the information they seek and are entitled to, according to Carol Levine of the United Hospital Fund. Healthcare professionals can share relevant information with family members unless the patient specifically objects. HIPAA is there to protect patients, and patients can share their health information with anyone they choose. To clarify patient rights under HIPAA, The United Hospital Fund has published easy-to-understand information on their Next Step in Care Web site.
(http://www.nextstepincare.org/next_step_in_care_guides/4/HIPAA/english)
Span P. “A Privacy Law Often Misinterpreted.” New York Times. March 7, 2013.
http://newoldage.blogs.nytimes.com/2013/03/27/a-privacy-law-often-misinterpreted/
General Health and Medicine
Leafy Greens Help Balance Your Immune System
Our long-time readers know that PDSA has always advocated eating leafy greens, especially kale and collards, for many reasons. Now there is another one. New research shows that leafy greens can switch on the genes that create innate lymphoid cells (ILCs), a type of immune cell that lives in our digestive system. “ILCs are essential for maintaining the delicate balance between tolerance, immunity and inflammation,” the very factors that play a part in developing ITP and maintaining low counts. The researchers, surprised that food could control gene expression, are exploring this further.
Press release. “Gene discovery reveals importance of eating your greens.” Walter+Elisa Hall Institute of Medical Research. April 3, 2013.
http://www.wehi.edu.au/site/latest_news/gene_discovery_reveals_importance_of_eating_your_greens
Rankin LC. “The transcription factor T-bet is essential for the development of NKp46+ innate lymphocytes via the Notch pathway.” Nature Immunology 14, 389–395 (2013).
http://www.nature.com/ni/journal/v14/n4/abs/ni.2545.html
Are Plastics and Your Hand Sanitizer Making you Sick?
Researchers looked at the urine levels of bisphenol A (BPA, found in many plastics) and triclosan (found in some hand sanitizers, toothpaste, and other products), both endocrine disrupters, in adults and children. They then compared the BPA and triclosan levels with the presence of cytomegalovirus (CMV) antibodies and the diagnosis of allergies and hay fever. In adults, BPA was associated with higher levels of CMV antibodies. Tricolsan was associated with a diagnosis of hay fever and allergies.
Note: CMV infections have been associated with the diagnosis of ITP (see “More Viruses Found in ITP Patients” above) and hay fever and allergies are a sign of an over-active immune system.
Clayton EM et al. “The impact of bisphenol A and triclosan on immune parameters in the U.S. population, NHANES 2003-2006.” Environ Health Perspect. 2011 Mar;119(3):390-6.
http://www.ncbi.nlm.nih.gov/pubmed/21062687
This e-newsletter is published by the Platelet Disorder Support Association, 133 Rollins Avenue, Suite 5, Rockville, MD 20852, phone 1-87-Platelet, fax: 301-770-6638, web: http://www.pdsa.org, e-mail: pdsa@pdsa.org
