| Citation: |
FANG Baozhi, ZHOU Yifei, SHEN Qiudan, YUAN Muzhi, YU Xiao, WANG Peng, LYU Ming'en. A case report of elderly patient with refractory severe aplastic anemia by treatment of avatrombopag in combination with tacrolimus[J]. Journal of Clinical Medicine in Practice, 2024, 28(3): 105-108. DOI: 10.7619/jcmp.20232344
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To summarize the clinical effect and adverse reactions of avatrombopag combined with tacrolimus in the treatment of elderly patient with refractory severe aplastic anemia.
An elderly patient with refractory severe aplastic anemia was treated with avatrombopag and tacrolimus, and the literature review on the mechanism of action and safety of avatrombopag and tacrolimus was conducted.
The patient was treated with a combination of cyclosporine, testosterone undecanoate, and itraconazole for 6 months without success, and developed liver and kidney dysfunction. The medication was discontinued, and the patient was treated with a combination of avatrombopag (20 mg, once per day) and tacrolimus (1 mg, twice per day). After 9 months of treatment, the patient's platelet count increased to 54×109/L, the hemoglobin increased to 124 g/L, the white blood cells increased to 8.23×109/L, liver and kidney function also returned to normal level, and no other adverse reactions such as thrombotic events were observed. After treatment, CD4/CD8 decreased, CD8+ T cells increased, and the proportion of Treg cells increased as well.
The combination of avatrombopag and tacrolimus is effective and well tolerated in the treatment of elderly patient with refractory aplastic anemia, but the long-term follow-up observation and continued accumulation of cases are still needed in the future.
| [1] |
付蓉, 王婷. 再生障碍性贫血诊断与治疗中国指南(2022年版)解读[J]. 中华血液学杂志, 2023, 44(3): 188-192.
|
| [2] |
KILLICK S B, BOWN N, CAVENAGH J, et al. Guidelines for the diagnosis and management of adult aplastic anaemia[J]. Br J Haematol, 2016, 172(2): 187-207. doi: 10.1111/bjh.13853
|
| [3] |
IFTIKHAR R, CHAUDHRY Q U N, ANWER F, et al. Allogeneic hematopoietic stem cell transplantation in aplastic anemia: current indications and transplant strategies[J]. Blood Rev, 2021, 47: 100772. doi: 10.1016/j.blre.2020.100772
|
| [4] |
任悦, 李杨, 刘春燕, 等. 他克莫司在治疗重型再生障碍性贫血中的免疫调节作用[J]. 中华医学杂志, 2021, 101(24): 1929-1934. doi: 10.3760/cma.j.cn112137-20201228-03484
|
| [5] |
SCHEINBERG P. Activity of eltrombopag in severe aplastic anemia[J]. Hematology Am Soc Hematol Educ Program, 2018, 2018(1): 450-456. doi: 10.1182/asheducation-2018.1.450
|
| [6] |
NOMOTO H, MORIMOTO N, MIURA K, et al. Lusutrombopag is effective and safe in patients with chronic liver disease and severe thrombocytopenia: a multicenter retrospective study[J]. BMC Gastroenterol, 2020, 20(1): 427. doi: 10.1186/s12876-020-01573-9
|
| [7] |
KULASEKARARAJ A G, MARSH J C W. Romiplostim in aplastic anaemia-another tool in the armamentarium[J]. Br J Haematol, 2021, 192(1): 15-16. doi: 10.1111/bjh.17189
|
| [8] |
SHIRLEY M. Avatrombopag: first global approval[J]. Drugs, 2018, 78(11): 1163-1168. doi: 10.1007/s40265-018-0949-8
|
| [9] |
QUINTINO DE OLIVEIRA B, CATTO L F B, SANTANA B A A, et al. Eltrombopag preferentially expands haematopoietic multipotent progenitors in human aplastic anaemia[J]. Br J Haematol, 2021, 193(2): 410-414. doi: 10.1111/bjh.17140
|
| [10] |
DESMOND R, TOWNSLEY D M, DUMITRIU B, et al. Eltrombopag restores trilineage hematopoiesis in refractory severe aplastic anemia that can be sustained on discontinuation of drug[J]. Blood, 2014, 123(12): 1818-1825. doi: 10.1182/blood-2013-10-534743
|
| [11] |
OLNES M J, SCHEINBERG P, CALVO K R, et al. Eltrombopag and improved hematopoiesis in refractory aplastic Anemia[J]. N Engl J Med, 2012, 367(1): 11-19. doi: 10.1056/NEJMoa1200931
|
| [12] |
TOWNSLEY D M, SCHEINBERG P, WINKLER T, et al. Eltrombopag added to standard immunosuppression for aplastic Anemia[J]. N Engl J Med, 2017, 376(16): 1540-1550. doi: 10.1056/NEJMoa1613878
|
| [13] |
GONZALEZ-PORRAS J R, BASTIDA J M. Eltrombopag in immune thrombocytopenia: efficacy review and update on drug safety[J]. Ther Adv Drug Saf, 2018, 9(6): 263-285. doi: 10.1177/2042098618769587
|
| [14] |
LEE J T, WHITSON B A, KELLY R F, et al. Calcineurin inhibitors and Clostridium difficile infection in adult lung transplant recipients: the effect of cyclosporine versus tacrolimus[J]. J Surg Res, 2013, 184(1): 599-604. doi: 10.1016/j.jss.2013.03.041
|
| [15] |
DU Y L, HUANG Y Z, ZHOU W Z, et al. Effective tacrolimus treatment for patients with non-severe aplastic Anemia that is refractory/intolerant to cyclosporine A: a retrospective study[J]. Drug Des Devel Ther, 2020, 14: 5711-5719. doi: 10.2147/DDDT.S275975
|
| [16] |
ABDELA J. Current advance in thrombopoietin receptor agonists in the management of thrombocytopenia associated with chronic liver disease: focus on avatrombopag[J]. Clin Med Insights Blood Disord, 2019, 12: 1179545X19875105.
|
| [17] |
FUKUSHIMA-SHINTANI M, SUZUKI K I, IWATSUKI Y, et al. AKR-501(YM477) a novel orally-active thrombopoietin receptor agonist[J]. Eur J Haematol, 2009, 82(4): 247-254. doi: 10.1111/j.1600-0609.2008.01198.x
|
| [18] |
BUSSEL J B, KUTER D J, ALEDORT L M, et al. A randomized trial of avatrombopag, an investigational thrombopoietin-receptor agonist, in persistent and chronic immune thrombocytopenia[J]. Blood, 2014, 123(25): 3887-3894. doi: 10.1182/blood-2013-07-514398
|
| [19] |
JURCZAK W, CHOJNOWSKI K, MAYER J, et al. Phase 3 randomised study of avatrombopag, a novel thrombopoietin receptor agonist for the treatment of chronic immune thrombocytopenia[J]. Br J Haematol, 2018, 183(3): 479-490.
|
| [20] |
刘晓庆, 杨慧, 李瑞鑫, 等. 阿伐曲泊帕治疗肝肾功能异常的严重型再生障碍性贫血8例分析[J]. 中国实用内科杂志, 2021, 41(10): 863-866, 889. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK202110011.htm
|
| [21] |
杨洁茹, 王化泉, 邵宗鸿. 艾曲泊帕治疗再生障碍性贫血作用机制的研究进展[J]. 中华医学杂志, 2020, 100(32): 2557-2560.
|
| [22] |
DING S X, LIANG X W, ZHANG T, et al. The effectiveness of rapamycin combined with eltrombopag in murine models of immune-mediated bone marrow failure[J]. J Immunol Res, 2020, 2020: 1798795.
|
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