title: Successful treatment of severe newly diagnosed immune thrombocytopenia involving an alveolar hemorrhage with combination therapy consisting of romiplostim, rituximab and vincristine.
abstract: A 51-year-old man was admitted due to a severe bleeding tendency. After he was diagnosed with immune thrombocytopenia (ITP), several therapies, including steroids, steroid pulse, vincristine and rituximab, were administered; however, the patient's bleeding symptoms were not sufficiently controllable with these treatments. Subsequently, a diffuse alveolar hemorrhage was observed. Treatment with a thrombopoietin receptor agonist, romiplostim, was initiated to prevent lethal hemorrhaging, although the efficacy of thrombopoietic receptor agonists in such emergency situations has not been elucidated. The initiation of romiplostim achieved prompt remission in platelets. This case suggests that combination therapy with romiplostim, rituximab and vincristine is effective in cases of newly diagnosed severe therapy-resistant ITP.
authors.affiliation: Division of Hematology, Niigata Univerisity Medical and Dental Hospital, Japan. kiyo.okazuka@gmail.com
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Okazuka
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Masuko
authors.forename: Yuji
authors.initials: Y
authors.lastname: Matsuo
authors.forename: Shukuko
authors.initials: S
authors.lastname: Miyakoshi
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Tanaka
authors.forename: Takashi
authors.initials: T
authors.lastname: Kozakai
authors.forename: Hironori
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Kyoko
authors.initials: K
authors.lastname: Fuse
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Shibasaki
authors.forename: Masato
authors.initials: M
authors.lastname: Moriyama
authors.forename: Jun
authors.initials: J
authors.lastname: Takizawa
authors.forename: Ichiro
authors.initials: I
authors.lastname: Fuse
authors.forename: Ken
authors.initials: K
authors.lastname: Toba
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Furukawa
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D006470:Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011650:Pulmonary Alveoli / Q000187:drug effects / Q000473:pathology*; D011961:Receptors, Fc / Q000008:administration & dosage*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D000069283:Rituximab; D012720:Severity of Illness Index; D013921:Thrombocytopenia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D013926:Thrombopoietin / Q000008:administration & dosage*; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage*
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D011961:Receptors, Fc; D011993:Recombinant Fusion Proteins; D000069283:Rituximab; D014750:Vincristine; D013926:Thrombopoietin; C488777:romiplostim