title: Chronic lymphocytic leukemia-associated refractory immune thrombocytopenia successfully treated with eltrombopag.
abstract: Chronic lymphocytic leukemia (CLL) may be associated with immune thrombocytopenia (ITP). The standard treatment for CLL-associated ITP is steroids. For refractory cases, various treatment strategies such as rituximab, splenectomy, and thrombopoietic mimetics are available. We report a patient with CLL who developed recurrent ITP and life-threatening pulmonary hemorrhage. Platelet counts remained extremely low despite massive platelet transfusion and treatment including steroids, immunoglobulin, and single-dose rituximab infusion. The bleeding stopped and platelet counts were increased to normal range 13 days after treatment with eltrombopag 25 mg per day. Our experience suggests that eltrombopag is an effective treatment option in CLL-associated, refractory ITP, especially during major bleeding, which requires relatively rapid improvement of thrombocytopenia.
authors.affiliation: School of Medicine, Chang Gung University, Kweishan Township, Taoyuan - Taiwan.
authors.forename: Hung
authors.initials: H
authors.lastname: Chang
authors.forename: Lee-Yung
authors.initials: LY
authors.lastname: Shih
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D001565:Benzoates / Q000627:therapeutic use*; D006470:Hemorrhage / Q000276:immunology* / Q000517:prevention & control; D006801:Humans; D006834:Hydrazines / Q000627:therapeutic use*; D007136:Immunoglobulins / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications* / Q000276:immunology; D008171:Lung Diseases / Q000276:immunology* / Q000517:prevention & control; D008297:Male; D010976:Platelet Count; D017713:Platelet Transfusion; D011720:Pyrazoles / Q000627:therapeutic use*; D000069283:Rituximab; D013921:Thrombocytopenia / Q000188:drug therapy* / Q000276:immunology* / Q000628:therapy
chemical_list: D000305:Adrenal Cortex Hormones; D058846:Antibodies, Monoclonal, Murine-Derived; D001565:Benzoates; D006834:Hydrazines; D007136:Immunoglobulins; D007155:Immunologic Factors; D011720:Pyrazoles; D000069283:Rituximab; C520809:eltrombopag