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Goronkova O, Novichkova G, Salimova T, Kalinina I, Baidildina D, Petrova U, Antonova K, Sadovskaya M, Suntsova E, Evseev D, Matveev V, Venyov D, Khachatryan L, Litvinov D, Pshonkin A, Ovsyannikova G, Kotskaya N, Gobadze D, Olshanskaya Y, Popov A, Raykina E, Mironenko O, Voronin K, Purbueva B, Boichenko E, Dinikina Y, Guseynova E, Sherstnev D, Kalinina E, Mezentsev S, Streneva O, Yudina N, Plaksina O, Erega E, Maschan M, Maschan A. Efficacy of combined immunosuppression with or without eltrombopag in children with newly diagnosed aplastic anemia. Blood Adv 2023; 7:953-962. [PMID: 35446936 PMCID: PMC10027512 DOI: 10.1182/bloodadvances.2021006716] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 11/20/2022] Open
Abstract
We compared the efficacy and safety of eltrombopag (ELTR) combined with immunosuppressive therapy (IST) and IST alone in treatment-naïve children with severe (SAA) and very severe (vSAA) aplastic anemia. Ninety-eight pediatric patients were randomized to receive horse antithymocyte globulin (hATG) and cyclosporin A (CsA) with (n = 49) or without (n = 49) ELTR. The primary endpoint was the overall response rate (ORR) at 4 months. After 4 months, nonresponders were crossed over to the alternative group. In all patients, the ORR in ELTR + IST and IST groups was similar (65% vs 53%; P = .218); however, the complete response (CR) rate was significantly higher in the ELTR + IST group (31% vs 12%; P = .027). In severity subgroups, the ORR was 89% vs 57% (P = .028) in favor of IST + ELTR in SAA, but it did not differ in patients with vSAA (52% vs 50%; P = .902). At 6 months after the crossover, 61% of initial ELTR(-) patients achieved a response compared with 17% of initial ELTR(+) patients (P = .016). No significant difference in ELTR + IST and IST groups was observed in the 3-year overall survival (OS) (89% vs 91%; P = .673) or the 3-year event-free survival (EFS) (53% vs 41%; P = .326). There was no unexpected toxicity related to ELTR. Adding ELTR to standard IST was well tolerated and increased the CR rate. The greatest benefit from ELTR combined with IST was observed in patients with SAA but not in those with vSAA. The second course of IST resulted in a high ORR in initial ELTR(-) patients who added ELTR and had limited efficacy among patients who received ELTR upfront. This trial was registered at Clinicaltrials.gov as #NCT03413306.
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Affiliation(s)
- Olga Goronkova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Galina Novichkova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Tatiana Salimova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Irina Kalinina
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Dina Baidildina
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Ulyana Petrova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Kristina Antonova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Maria Sadovskaya
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Elena Suntsova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Dmitry Evseev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Victor Matveev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Dmitry Venyov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Lili Khachatryan
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Dmitry Litvinov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Alexey Pshonkin
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Galina Ovsyannikova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Natalia Kotskaya
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Darina Gobadze
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Yulia Olshanskaya
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Alexander Popov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Elena Raykina
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Olga Mironenko
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Kirill Voronin
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | | | - Elmira Boichenko
- St. Petersburg Children's City Hospital No 1, St. Petersburg, Russia
| | - Yulia Dinikina
- Almazov National Medical Research Center, St. Petersburg, Russia
| | | | - Dmitry Sherstnev
- Shustov University Clinical Hospital No 3 of Razumovsky Saratov State Medical University, Saratov, Russia
| | - Elena Kalinina
- Samara Regional Clinical Children's Hospital, Samara, Russia
| | | | - Olga Streneva
- Ekaterinburg Regional Clinical Children's Hospital, Ekaterinburg, Russia
| | - Natalia Yudina
- Voronezh Regional Clinical Children's Hospital No 1, Voronezh, Russia
| | - Olga Plaksina
- Regional Clinical Children's Hospital, Nizhniy Novgorod, Russia
| | - Elena Erega
- Piotrovich Regional Clinical Children's Hospital, Khabarovsk, Russia
| | - Michael Maschan
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Alexey Maschan
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
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Aksenova M, Sulejmanova A, Petrova U, Laberco A, Kachanov D, Shcherbina A, Hamin I, Maschian A. FP328SECONDARY THROMBOTIC MICROANGIOPATHY: DO WE HAVE PROSPECTS FOR THERAPY? Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Marina Aksenova
- D.Rogacev Federal Scientific-Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Amina Sulejmanova
- D.Rogacev Federal Scientific-Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Ulyana Petrova
- D.Rogacev Federal Scientific-Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Alexandra Laberco
- D.Rogacev Federal Scientific-Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Denis Kachanov
- D.Rogacev Federal Scientific-Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Anna Shcherbina
- D.Rogacev Federal Scientific-Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Igor Hamin
- D.Rogacev Federal Scientific-Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Alexey Maschian
- D.Rogacev Federal Scientific-Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
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Grunewald TGP, Damke L, Maschan M, Petrova U, Surianinova O, Esipenko A, Konovalov D, Behrends U, Schiessl J, Wörtler K, Burdach S, von Luettichau I. First report of effective and feasible treatment of multifocal lymphangiomatosis (Gorham-Stout) with bevacizumab in a child. Ann Oncol 2010; 21:1733-1734. [PMID: 20605931 DOI: 10.1093/annonc/mdq331] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- T G P Grunewald
- Department of Paediatrics, Klinikum rechts der Isar, Technische Universität München; Laboratory of Functional Genomics and Transplantation Biology, Children's Cancer Research Center, Paediatric Oncology and Roman Herzog Comprehensive Cancer Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - L Damke
- Department of Paediatrics, Klinikum rechts der Isar, Technische Universität München
| | - M Maschan
- Department of Haematology, Federal Clinical Research Center for Paediatric Haematology, Oncology and Immunology, Moscow
| | - U Petrova
- Department of Haematology-1, Russian Children's Clinical Hospital, Moscow
| | - O Surianinova
- Department of Haematology, Yaroslavl Regional Children's Hospital, Yaroslavl
| | - A Esipenko
- Department of Haematology, Yaroslavl Regional Children's Hospital, Yaroslavl
| | - D Konovalov
- Department of Pathology, Federal Clinical Research Center for Paediatric Haematology, Oncology and Immunology, Moscow, Russian Federation
| | - U Behrends
- Department of Paediatrics, Klinikum rechts der Isar, Technische Universität München
| | - J Schiessl
- Department of Pathology, Klinikum Schwabing
| | - K Wörtler
- Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - S Burdach
- Department of Paediatrics, Klinikum rechts der Isar, Technische Universität München; Laboratory of Functional Genomics and Transplantation Biology, Children's Cancer Research Center, Paediatric Oncology and Roman Herzog Comprehensive Cancer Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - I von Luettichau
- Department of Paediatrics, Klinikum rechts der Isar, Technische Universität München.
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