SlideShare a Scribd company logo
1 of 22
Download to read offline
JOURNAL CLUB
MODULE: HEMATOLOGY
DR. SADIA BATOOL
RESIDENT GMT2,PIMS
STUDY: 1
• Amifostine and rituximab in refractory immune thrombocytopenia : A case series
OBJECTIVE
• Management of refractory ITP can be challenging,amifostine, a thiophosphate
prodrug induces mega karyocyte maturation.
• In 2010,Fan et al. published results for 21 Chinese splenectomized patients,aged
13-92,with steroid refractory ITP. Nineteen patients achieved remission 2 months
post-amifostine
• This is the first publication utilizing amifostine and rituximab in refractory ITP.
MATERIALS AND METHODS
• At the Cairns hospital in Australia,five patients were identified who were treated with
amifostine and rituximab for refractory ITP.
• Amifostine IV 400mg once daily was administered 5 days per week for 5 weeks.
• Rituximab was administered concurrently with/preceding amifostine based on clinician
preference.
• Data were obtained through medical records and follow up serology up to 5 years post
amifostine was available.
RESULTS
• Three case demonstrated durable responses up to 5 years’ follow up.
• One patient initally achieved remission but relapsed 1 year post amifostine.
• One patient who did not have a splenectomy prior to amifostine did not
respond.
CONCLUSION
• Three out of five patients achieved durable responses with amifostine and
rituximab. Although there is confounding by rituximab ,given its established low
durable response rate,it is likely that the excellent long term responses achieved
were a result of amifostine.
• Clinical trials with larger patient cohorts and further investigations are required to
confirm the efficacy and mechanism of amifostine in ITP.
STUDY: 2
Comparison of splenectomy and Eltrombopag treatment in the second line
treatment of immune thrombocytopenic purpura.
OBJECTIVE
• Primary ITP is an acquired autoimmune disease characterized by isolated
thrombocytopenia.
• While first line treatments focus on inhibiting autoantibodies and platelet
destruction,second and third lline treatments include splenectomy and
thrombopoietin receptor agonists.
• In this study aim was to compare efficiency and toxicities of splenectomy and
eltrombopag as second line treatments in ITP.
MATERIALS AND METHODS
• Retrospectively analyzed patients who were diagnosed with ITP and followed
between 2015 and 2020.
• Patients who underwent splenectomy or received eltrombopag treatment as
second line or further therapy were included.
RESULTS
• There were 38 patients in the splenectomy group and 47 patients in the
eltrombopag group.
• Mean age; 43.2 and 50.5
• Time to response was significantly shorter in the splenectomy arm (0.001).
However response rates at 3rd,6th,12th and 24 months did not exhibit a statistically
significant difference.
• Eltrombopag treatment was ceased for 20 patients after a median of 54.1 months
(range 1-151).among them 12 patients (60%) did not experience a loss of
response.
CONCLUSION
• Comparing the splenectomy and eltrombopag arms,even though time to achieve
response was in favor of splenectomy group,this advantage disappeared when
overall response rates and response rates at the 2nd year were considered.
• using eltrombopag in the second or 3rd line therapy does not yield any difference
in terms of time to achieving response.
STUDY:3
Efficacy and safety of Roxadustat for anemia in dialysis dependant and non dialysis
dependant chronic kidney disease patients, a systemic review and meta analysis
AIMS
• Renal anemia is a common complication of CKD. Roxadustat is the first in class
oral hypoxia inducible factor prolyl hydroxylase inhibitor for the treatment of
anemia.
• In this systematic review,we aimed to investigate the efficacy and safety of
Roxadustat in the treatment of anemia in CKD patients.
METHODS
• Pubmed,Cochrane library.Embase and clinical trials.gov databases were searched
from their inception to feb, 2021 for randomized controlled trials (RCTs) that
compared the safety and efficacy of Roxadustat to those of an erythropoiesis
stimulating agent or a placebo in treating anemia in CKD patients.
RESULTS
• Nine RCTs involving 2743 patients were found. The meta-analysis showed that
roxadustat increased haemoglobin (Hb) level by 0.91 g/dL (95% confidence interval
[CI]: 0.47-1.34, P < .05), transferrin level by 0.50 mg/dL (95% CI: 0.34-0.65, P < .05),
and total iron-binding capacity by 50.64 μg/dL (95% CI: 36.21-65.07, P < .05) in CKD
patients. Decreases in hepcidin (mean difference [MD] = -23.16, 95% CI: -37.12 to -
9.19, P < .05) and ferritin (MD = -38.35, 95% CI: -67.41 to -9.29, P < .05) levels were
also observed.
• There was no significant difference in the incidence of adverse events (AEs) (OR: 1.12,
95% CI: 0.95-1.32, P = .17) between the roxadustat and control groups; however, the
incidence of serious AEs in the roxadustat group was significantly higher than that in
the ESA group (OR: 1.33, 95% CI: 1.06-1.68, P < .05).
CONCLUSION
• Roxadustat can significantly improve renal anaemia in CKD patients by increasing
Hb level and iron metabolism. However, attention must be paid to the risk of SAEs
during treatment.
STUDY: 4
• Meta analysis of treatment with rabbit and horse antithymocyte
globulin for aplastic anemia
INTRODUCTION
• Aplastic anemia is an immune mediated bone marrow disorder that is associated
with bone marrow cell destruction and peripheral blood pancytopenia.
• Hematopoeitic system cell transplantation is recommended for young patients.
• ATG and cyclosporin are used in combination as s standard immunosuppressive
regimen.
• ATG is a polygonal immunoglobulin that is produced by animals immunized by
specific antigens.
MATERIALS AND METHODS
• Non randomized controlled trials and prospective and retrospective cohort
studies in addition to RCTs were included.
• It included clinical studies that compared two or more different ATG regimens for
aplastic anemia as the first line treatment for aplastic anemia.
• Published literature in pubmed from 1946-2014, Cochrane library from inception
to june2014,the web of science from 1980 to 8th june2014 was used.
• The clinical outcomes of rabbit ATG and horse ATG were compared.
• The primary outcome measure was the early mortality at 3 months after
treatment with ATG.
• Secondary outcome measure was overall response rate at 6 months.
• OVERALL RESPONSE: blood count recovery not meeting the severe aplastic
anemia criteria and transfusion independancy.
RESULTS
• The number of studies that used lymphoglobulins and ATGAM were 8 and 2
respectively.
• Early mortality was 7.5% 55 in 734 patients) in thymoglobulin group and 4.1% (33
in 798 patients) in lymphoglobulin group. (P= 0.016)
• Overall response was obtained from 10 studies,seven studies used
lymphoglobulins as horse ATG and 3 used ATGAM.
• Overall response at 6 months was significantly higher in lypmhoglobuline/
ATGAM than in thymoglobulin group. (RR 1.27; 95% CI 1.05-1.54, P=0.014)
JOURNAL CLUB hematology.pptx

More Related Content

Similar to JOURNAL CLUB hematology.pptx

JC-3.pptx
JC-3.pptxJC-3.pptx
JC-3.pptxqwhegd
 
Advances in the management of pediatric septic shock
Advances in the management of pediatric septic shockAdvances in the management of pediatric septic shock
Advances in the management of pediatric septic shockDr. Vinaykumar S Appannavar
 
lupus-nephritis.ppt
lupus-nephritis.pptlupus-nephritis.ppt
lupus-nephritis.pptShinilLenin
 
Residual Platelet Reactivity, Bleedings, and Adherence to Treatment in Patien...
Residual Platelet Reactivity, Bleedings, and Adherence toTreatment in Patien...Residual Platelet Reactivity, Bleedings, and Adherence toTreatment in Patien...
Residual Platelet Reactivity, Bleedings, and Adherence to Treatment in Patien...Nagi Abdalla
 
Initial Therapy in CLL
Initial Therapy in CLLInitial Therapy in CLL
Initial Therapy in CLLroysudip900
 
Pembrolizumab in advanced melanoma
Pembrolizumab in advanced melanomaPembrolizumab in advanced melanoma
Pembrolizumab in advanced melanomaRanjita Pallavi
 
Most Recent Studies About Stem Cell & Autoimmune Disease
Most Recent Studies About Stem Cell & Autoimmune DiseaseMost Recent Studies About Stem Cell & Autoimmune Disease
Most Recent Studies About Stem Cell & Autoimmune Diseasemeducationdotnet
 
sirolimus in hyperinsulnisim Journal club
sirolimus in hyperinsulnisim     Journal clubsirolimus in hyperinsulnisim     Journal club
sirolimus in hyperinsulnisim Journal clubYassin Alsaleh
 
REVIEW OF THERAPIES FOR PULMONARY EMBOLISM .pptx
REVIEW OF THERAPIES FOR PULMONARY EMBOLISM .pptxREVIEW OF THERAPIES FOR PULMONARY EMBOLISM .pptx
REVIEW OF THERAPIES FOR PULMONARY EMBOLISM .pptxNihanth73
 
Prevention of contrast nephropathy,CIN.
Prevention of contrast nephropathy,CIN.Prevention of contrast nephropathy,CIN.
Prevention of contrast nephropathy,CIN.Dr.Hasan Mahmud
 
Adjusting drug dosing in ECMO patients
Adjusting drug dosing in ECMO patients Adjusting drug dosing in ECMO patients
Adjusting drug dosing in ECMO patients Dr.Mahmoud Abbas
 
SLE: present guidelines and consensus
SLE: present guidelines and consensusSLE: present guidelines and consensus
SLE: present guidelines and consensusVishal Golay
 
Riociguat for the treatment of pah
Riociguat for the treatment of pahRiociguat for the treatment of pah
Riociguat for the treatment of pahVishwanath Hesarur
 
Empagliflozin in acute myocardial infarction.pptx
Empagliflozin in acute myocardial infarction.pptxEmpagliflozin in acute myocardial infarction.pptx
Empagliflozin in acute myocardial infarction.pptxpurraSameer
 
Modified therapeutic plasma-exchange
Modified therapeutic plasma-exchangeModified therapeutic plasma-exchange
Modified therapeutic plasma-exchangeFarragBahbah
 
ADAPT FRIDA trial.pptx
ADAPT FRIDA trial.pptxADAPT FRIDA trial.pptx
ADAPT FRIDA trial.pptxNeurologyKota
 

Similar to JOURNAL CLUB hematology.pptx (20)

JC-3.pptx
JC-3.pptxJC-3.pptx
JC-3.pptx
 
Advances in the management of pediatric septic shock
Advances in the management of pediatric septic shockAdvances in the management of pediatric septic shock
Advances in the management of pediatric septic shock
 
lupus-nephritis.ppt
lupus-nephritis.pptlupus-nephritis.ppt
lupus-nephritis.ppt
 
lupus-nephritis.ppt
lupus-nephritis.pptlupus-nephritis.ppt
lupus-nephritis.ppt
 
Residual Platelet Reactivity, Bleedings, and Adherence to Treatment in Patien...
Residual Platelet Reactivity, Bleedings, and Adherence toTreatment in Patien...Residual Platelet Reactivity, Bleedings, and Adherence toTreatment in Patien...
Residual Platelet Reactivity, Bleedings, and Adherence to Treatment in Patien...
 
Initial Therapy in CLL
Initial Therapy in CLLInitial Therapy in CLL
Initial Therapy in CLL
 
Pembrolizumab in advanced melanoma
Pembrolizumab in advanced melanomaPembrolizumab in advanced melanoma
Pembrolizumab in advanced melanoma
 
Most Recent Studies About Stem Cell & Autoimmune Disease
Most Recent Studies About Stem Cell & Autoimmune DiseaseMost Recent Studies About Stem Cell & Autoimmune Disease
Most Recent Studies About Stem Cell & Autoimmune Disease
 
sirolimus in hyperinsulnisim Journal club
sirolimus in hyperinsulnisim     Journal clubsirolimus in hyperinsulnisim     Journal club
sirolimus in hyperinsulnisim Journal club
 
REVIEW OF THERAPIES FOR PULMONARY EMBOLISM .pptx
REVIEW OF THERAPIES FOR PULMONARY EMBOLISM .pptxREVIEW OF THERAPIES FOR PULMONARY EMBOLISM .pptx
REVIEW OF THERAPIES FOR PULMONARY EMBOLISM .pptx
 
Prevention of contrast nephropathy,CIN.
Prevention of contrast nephropathy,CIN.Prevention of contrast nephropathy,CIN.
Prevention of contrast nephropathy,CIN.
 
Adjusting drug dosing in ECMO patients
Adjusting drug dosing in ECMO patients Adjusting drug dosing in ECMO patients
Adjusting drug dosing in ECMO patients
 
SLE: present guidelines and consensus
SLE: present guidelines and consensusSLE: present guidelines and consensus
SLE: present guidelines and consensus
 
Riociguat for the treatment of pah
Riociguat for the treatment of pahRiociguat for the treatment of pah
Riociguat for the treatment of pah
 
Anemia mih
Anemia  mihAnemia  mih
Anemia mih
 
Empagliflozin in acute myocardial infarction.pptx
Empagliflozin in acute myocardial infarction.pptxEmpagliflozin in acute myocardial infarction.pptx
Empagliflozin in acute myocardial infarction.pptx
 
Modified therapeutic plasma-exchange
Modified therapeutic plasma-exchangeModified therapeutic plasma-exchange
Modified therapeutic plasma-exchange
 
Plasmapheresis in ICU
Plasmapheresis in ICUPlasmapheresis in ICU
Plasmapheresis in ICU
 
ADAPT FRIDA trial.pptx
ADAPT FRIDA trial.pptxADAPT FRIDA trial.pptx
ADAPT FRIDA trial.pptx
 
Drug modification in crrt
Drug modification in crrt Drug modification in crrt
Drug modification in crrt
 

Recently uploaded

cerebrovasular disease(ischemic, ICH & SAH).pptx
cerebrovasular disease(ischemic, ICH & SAH).pptxcerebrovasular disease(ischemic, ICH & SAH).pptx
cerebrovasular disease(ischemic, ICH & SAH).pptxMohamed Rizk Khodair
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
Endocrine Pancreas- Insulin and Diabetes mellitus
Endocrine Pancreas- Insulin and Diabetes mellitusEndocrine Pancreas- Insulin and Diabetes mellitus
Endocrine Pancreas- Insulin and Diabetes mellitusSai Sailesh Kumar Goothy
 
Is It Time To Consider A Hearing Aid Look For These Signs
Is It Time To Consider A Hearing Aid Look For These SignsIs It Time To Consider A Hearing Aid Look For These Signs
Is It Time To Consider A Hearing Aid Look For These SignsSoundak
 
Double Lumen Tube presentation by Dr. Animesh Aman Singh
Double Lumen Tube presentation by Dr. Animesh Aman SinghDouble Lumen Tube presentation by Dr. Animesh Aman Singh
Double Lumen Tube presentation by Dr. Animesh Aman Singh19anisingh
 
Let's Talk About It: Uterine Cancer (Advance Care Planning)
Let's Talk About It: Uterine Cancer (Advance Care Planning)Let's Talk About It: Uterine Cancer (Advance Care Planning)
Let's Talk About It: Uterine Cancer (Advance Care Planning)bkling
 
Marek's disease, transmission, pathogenesis .pptx
Marek's disease, transmission, pathogenesis .pptxMarek's disease, transmission, pathogenesis .pptx
Marek's disease, transmission, pathogenesis .pptxDr-Haseeb Tagar
 
Vaccines: Will they become a form of Secondary and Primary Breast Cancer Prev...
Vaccines: Will they become a form of Secondary and Primary Breast Cancer Prev...Vaccines: Will they become a form of Secondary and Primary Breast Cancer Prev...
Vaccines: Will they become a form of Secondary and Primary Breast Cancer Prev...bkling
 
Dental Digital Scanners: Intraoral and Extraoral 3D Scanners
Dental Digital Scanners: Intraoral and Extraoral 3D ScannersDental Digital Scanners: Intraoral and Extraoral 3D Scanners
Dental Digital Scanners: Intraoral and Extraoral 3D Scannersassem awad
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
1130329-高雄地區第496次小兒科聯合病例討論會-高雄市立聯合醫院.pdf
1130329-高雄地區第496次小兒科聯合病例討論會-高雄市立聯合醫院.pdf1130329-高雄地區第496次小兒科聯合病例討論會-高雄市立聯合醫院.pdf
1130329-高雄地區第496次小兒科聯合病例討論會-高雄市立聯合醫院.pdfKs doctor
 
Staying Safe in Hospitals Fire Safety Guidelines for Hospitals in India
Staying Safe in Hospitals Fire Safety Guidelines for Hospitals in IndiaStaying Safe in Hospitals Fire Safety Guidelines for Hospitals in India
Staying Safe in Hospitals Fire Safety Guidelines for Hospitals in IndiaBasic Elements
 
EICOSONOIDS METABOLISM FOR MBBS, LAB. MED.BDS.pptx
EICOSONOIDS METABOLISM FOR MBBS, LAB. MED.BDS.pptxEICOSONOIDS METABOLISM FOR MBBS, LAB. MED.BDS.pptx
EICOSONOIDS METABOLISM FOR MBBS, LAB. MED.BDS.pptxRajendra Dev Bhatt
 
Pregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdfPregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdfMedicoseAcademics
 
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxGood Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxLikeways
 
Introduction to basic Molecular Biology.pptx
Introduction to basic Molecular Biology.pptxIntroduction to basic Molecular Biology.pptx
Introduction to basic Molecular Biology.pptxseeratefatima
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 

Recently uploaded (20)

cerebrovasular disease(ischemic, ICH & SAH).pptx
cerebrovasular disease(ischemic, ICH & SAH).pptxcerebrovasular disease(ischemic, ICH & SAH).pptx
cerebrovasular disease(ischemic, ICH & SAH).pptx
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
PROTOCOL
PROTOCOLPROTOCOL
PROTOCOL
 
Cone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptxCone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptx
 
Endocrine Pancreas- Insulin and Diabetes mellitus
Endocrine Pancreas- Insulin and Diabetes mellitusEndocrine Pancreas- Insulin and Diabetes mellitus
Endocrine Pancreas- Insulin and Diabetes mellitus
 
Is It Time To Consider A Hearing Aid Look For These Signs
Is It Time To Consider A Hearing Aid Look For These SignsIs It Time To Consider A Hearing Aid Look For These Signs
Is It Time To Consider A Hearing Aid Look For These Signs
 
Double Lumen Tube presentation by Dr. Animesh Aman Singh
Double Lumen Tube presentation by Dr. Animesh Aman SinghDouble Lumen Tube presentation by Dr. Animesh Aman Singh
Double Lumen Tube presentation by Dr. Animesh Aman Singh
 
Let's Talk About It: Uterine Cancer (Advance Care Planning)
Let's Talk About It: Uterine Cancer (Advance Care Planning)Let's Talk About It: Uterine Cancer (Advance Care Planning)
Let's Talk About It: Uterine Cancer (Advance Care Planning)
 
Marek's disease, transmission, pathogenesis .pptx
Marek's disease, transmission, pathogenesis .pptxMarek's disease, transmission, pathogenesis .pptx
Marek's disease, transmission, pathogenesis .pptx
 
Vaccines: Will they become a form of Secondary and Primary Breast Cancer Prev...
Vaccines: Will they become a form of Secondary and Primary Breast Cancer Prev...Vaccines: Will they become a form of Secondary and Primary Breast Cancer Prev...
Vaccines: Will they become a form of Secondary and Primary Breast Cancer Prev...
 
Dental Digital Scanners: Intraoral and Extraoral 3D Scanners
Dental Digital Scanners: Intraoral and Extraoral 3D ScannersDental Digital Scanners: Intraoral and Extraoral 3D Scanners
Dental Digital Scanners: Intraoral and Extraoral 3D Scanners
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
1130329-高雄地區第496次小兒科聯合病例討論會-高雄市立聯合醫院.pdf
1130329-高雄地區第496次小兒科聯合病例討論會-高雄市立聯合醫院.pdf1130329-高雄地區第496次小兒科聯合病例討論會-高雄市立聯合醫院.pdf
1130329-高雄地區第496次小兒科聯合病例討論會-高雄市立聯合醫院.pdf
 
Staying Safe in Hospitals Fire Safety Guidelines for Hospitals in India
Staying Safe in Hospitals Fire Safety Guidelines for Hospitals in IndiaStaying Safe in Hospitals Fire Safety Guidelines for Hospitals in India
Staying Safe in Hospitals Fire Safety Guidelines for Hospitals in India
 
EICOSONOIDS METABOLISM FOR MBBS, LAB. MED.BDS.pptx
EICOSONOIDS METABOLISM FOR MBBS, LAB. MED.BDS.pptxEICOSONOIDS METABOLISM FOR MBBS, LAB. MED.BDS.pptx
EICOSONOIDS METABOLISM FOR MBBS, LAB. MED.BDS.pptx
 
Pregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdfPregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdf
 
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxGood Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
 
Introduction to basic Molecular Biology.pptx
Introduction to basic Molecular Biology.pptxIntroduction to basic Molecular Biology.pptx
Introduction to basic Molecular Biology.pptx
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 

JOURNAL CLUB hematology.pptx

  • 1. JOURNAL CLUB MODULE: HEMATOLOGY DR. SADIA BATOOL RESIDENT GMT2,PIMS
  • 2. STUDY: 1 • Amifostine and rituximab in refractory immune thrombocytopenia : A case series
  • 3. OBJECTIVE • Management of refractory ITP can be challenging,amifostine, a thiophosphate prodrug induces mega karyocyte maturation. • In 2010,Fan et al. published results for 21 Chinese splenectomized patients,aged 13-92,with steroid refractory ITP. Nineteen patients achieved remission 2 months post-amifostine • This is the first publication utilizing amifostine and rituximab in refractory ITP.
  • 4. MATERIALS AND METHODS • At the Cairns hospital in Australia,five patients were identified who were treated with amifostine and rituximab for refractory ITP. • Amifostine IV 400mg once daily was administered 5 days per week for 5 weeks. • Rituximab was administered concurrently with/preceding amifostine based on clinician preference. • Data were obtained through medical records and follow up serology up to 5 years post amifostine was available.
  • 5. RESULTS • Three case demonstrated durable responses up to 5 years’ follow up. • One patient initally achieved remission but relapsed 1 year post amifostine. • One patient who did not have a splenectomy prior to amifostine did not respond.
  • 6. CONCLUSION • Three out of five patients achieved durable responses with amifostine and rituximab. Although there is confounding by rituximab ,given its established low durable response rate,it is likely that the excellent long term responses achieved were a result of amifostine. • Clinical trials with larger patient cohorts and further investigations are required to confirm the efficacy and mechanism of amifostine in ITP.
  • 7. STUDY: 2 Comparison of splenectomy and Eltrombopag treatment in the second line treatment of immune thrombocytopenic purpura.
  • 8. OBJECTIVE • Primary ITP is an acquired autoimmune disease characterized by isolated thrombocytopenia. • While first line treatments focus on inhibiting autoantibodies and platelet destruction,second and third lline treatments include splenectomy and thrombopoietin receptor agonists. • In this study aim was to compare efficiency and toxicities of splenectomy and eltrombopag as second line treatments in ITP.
  • 9. MATERIALS AND METHODS • Retrospectively analyzed patients who were diagnosed with ITP and followed between 2015 and 2020. • Patients who underwent splenectomy or received eltrombopag treatment as second line or further therapy were included.
  • 10. RESULTS • There were 38 patients in the splenectomy group and 47 patients in the eltrombopag group. • Mean age; 43.2 and 50.5 • Time to response was significantly shorter in the splenectomy arm (0.001). However response rates at 3rd,6th,12th and 24 months did not exhibit a statistically significant difference. • Eltrombopag treatment was ceased for 20 patients after a median of 54.1 months (range 1-151).among them 12 patients (60%) did not experience a loss of response.
  • 11. CONCLUSION • Comparing the splenectomy and eltrombopag arms,even though time to achieve response was in favor of splenectomy group,this advantage disappeared when overall response rates and response rates at the 2nd year were considered. • using eltrombopag in the second or 3rd line therapy does not yield any difference in terms of time to achieving response.
  • 12. STUDY:3 Efficacy and safety of Roxadustat for anemia in dialysis dependant and non dialysis dependant chronic kidney disease patients, a systemic review and meta analysis
  • 13. AIMS • Renal anemia is a common complication of CKD. Roxadustat is the first in class oral hypoxia inducible factor prolyl hydroxylase inhibitor for the treatment of anemia. • In this systematic review,we aimed to investigate the efficacy and safety of Roxadustat in the treatment of anemia in CKD patients.
  • 14. METHODS • Pubmed,Cochrane library.Embase and clinical trials.gov databases were searched from their inception to feb, 2021 for randomized controlled trials (RCTs) that compared the safety and efficacy of Roxadustat to those of an erythropoiesis stimulating agent or a placebo in treating anemia in CKD patients.
  • 15. RESULTS • Nine RCTs involving 2743 patients were found. The meta-analysis showed that roxadustat increased haemoglobin (Hb) level by 0.91 g/dL (95% confidence interval [CI]: 0.47-1.34, P < .05), transferrin level by 0.50 mg/dL (95% CI: 0.34-0.65, P < .05), and total iron-binding capacity by 50.64 μg/dL (95% CI: 36.21-65.07, P < .05) in CKD patients. Decreases in hepcidin (mean difference [MD] = -23.16, 95% CI: -37.12 to - 9.19, P < .05) and ferritin (MD = -38.35, 95% CI: -67.41 to -9.29, P < .05) levels were also observed. • There was no significant difference in the incidence of adverse events (AEs) (OR: 1.12, 95% CI: 0.95-1.32, P = .17) between the roxadustat and control groups; however, the incidence of serious AEs in the roxadustat group was significantly higher than that in the ESA group (OR: 1.33, 95% CI: 1.06-1.68, P < .05).
  • 16. CONCLUSION • Roxadustat can significantly improve renal anaemia in CKD patients by increasing Hb level and iron metabolism. However, attention must be paid to the risk of SAEs during treatment.
  • 17. STUDY: 4 • Meta analysis of treatment with rabbit and horse antithymocyte globulin for aplastic anemia
  • 18. INTRODUCTION • Aplastic anemia is an immune mediated bone marrow disorder that is associated with bone marrow cell destruction and peripheral blood pancytopenia. • Hematopoeitic system cell transplantation is recommended for young patients. • ATG and cyclosporin are used in combination as s standard immunosuppressive regimen. • ATG is a polygonal immunoglobulin that is produced by animals immunized by specific antigens.
  • 19. MATERIALS AND METHODS • Non randomized controlled trials and prospective and retrospective cohort studies in addition to RCTs were included. • It included clinical studies that compared two or more different ATG regimens for aplastic anemia as the first line treatment for aplastic anemia. • Published literature in pubmed from 1946-2014, Cochrane library from inception to june2014,the web of science from 1980 to 8th june2014 was used. • The clinical outcomes of rabbit ATG and horse ATG were compared.
  • 20. • The primary outcome measure was the early mortality at 3 months after treatment with ATG. • Secondary outcome measure was overall response rate at 6 months. • OVERALL RESPONSE: blood count recovery not meeting the severe aplastic anemia criteria and transfusion independancy.
  • 21. RESULTS • The number of studies that used lymphoglobulins and ATGAM were 8 and 2 respectively. • Early mortality was 7.5% 55 in 734 patients) in thymoglobulin group and 4.1% (33 in 798 patients) in lymphoglobulin group. (P= 0.016) • Overall response was obtained from 10 studies,seven studies used lymphoglobulins as horse ATG and 3 used ATGAM. • Overall response at 6 months was significantly higher in lypmhoglobuline/ ATGAM than in thymoglobulin group. (RR 1.27; 95% CI 1.05-1.54, P=0.014)