Immunological characteristics and effect of cyclosporin in patients with immune thrombocytopenia

Abstract

Objective Immune thrombocytopenia (ITP) is well‐known as an antibody‐mediated autoimmune disease, and it is easy to get response but often turns to relapse or refractory. Cyclosporin is a traditional immunosuppressant and had a good effect on ITP patients. In this paper, we retrospectively analyze the immunological characteristics and therapeutic effect of cyclosporin in 220 patients with ITP. Methods All newly diagnosed ITP patients in the Department of Hematology, Tianjin Medical University General Hospital from June 2018 to December 2020 were enrolled and divided into four groups according to the expression of autoantibodies and the occurrence of prodromal infection. The basic data and immune indexes of ITP patients in each group were collected. The clinical immunological characteristics of patients in each group and the therapeutic effect of cyclosporin in each group were analyzed. Results Multi‐autoantibody ITP patients were more likely to have low serum albumin and high gamma globulin, and the ratio of albumin to globulin decreased. In addition, the level of IgA and IgG increased and the level of complement C3 and C4 decreased more frequently than those in other groups. The number of CD3+T lymphocytes, especially CD3+CD4+T lymphocytes, decreased in ANA+ITP patients. The number of CD16+CD56+NK cells, pDC/DC ratio, and pDC/mDC ratio were higher than those in other groups. The expression of IL‐6 and the proportion of CD19+B lymphocytes increased in two groups of ITP patients with abnormal autoantibodies. The patients of pro‐infected group were more likely to suffer from coagulation disorder. After treatment with cyclosporin, the response rate increased and the 3‐month relapse rate decreased in all ITP patients, and the therapeutic effect of patients with high megakaryocyte number was significantly higher than that of patients with low megakaryocyte number. The impact factors that influence the effect of glucocorticoid and(or) IVIG were the number of CD3+CD8+T lymphocytes, CD4/CD8 cell ratio, and the number of CD19+B lymphocytes. The independent impact factor of cyclosporin therapeutic response rate was the number of CD3+T lymphocytes. Conclusions ITP is a heterogeneous disease, recurrence may occur during or rapidly after treatment. Cyclosporine included treatment can improve the effective rate of ITP and reduce the relapse rate within 3 months. The number of CD3+T lymphocytes was the only impact factor that influence the therapeutic effect of cyclosporin in ITP patients.

Efficacy and safety of cyclosporine A treatment in autoimmune cytopenias: the experience of two Italian reference centers

“…A total of 23 reports have been published involving the use of CyA in AIC for a total of 441 patients ( Table 3 ). They were mainly pediatric studies (60%) and included 10 case reports/series, 9 – 18 8 clinical trials, 19 – 26 and 5 retrospective studies 27 – 31 of CyA used as single agent or in combination.…”

Efficacy and safety of cyclosporine-based regimens for primary immune thrombocytopenia: a systematic review and meta-analysis

“… 29 – 32 Cyclosporine can regulate abnormal immune cells in patients with ITP, suppress abnormally activated immune responses, and play an important role in the protection of platelets coated with anti-platelet autoantibodies. 12 Related research found that after repeated cyclosporine A administration, two patients with chronic severe refractory ITP experienced long-term complete remission, and their adverse reactions were relatively mild. 33 The results of the present analysis demonstrated that cyclosporine-based combination therapy can effectively improve the condition of patients with a certain degree of safety.…”

“… 10 , 11 Furthermore, as the main second-line drug for the treatment of ITP, cyclosporine can improve the total effective rate of clinical treatment in patients with ITP and reduce the recurrence rate. 12 , 13 A recent retrospective study found that cyclosporine effectively treated children with refractory ITP and prevented splenectomy. 14 …”

“…10,11 Furthermore, as the main second-line drug for the treatment of ITP, cyclosporine can improve the total effective rate of clinical treatment in patients with ITP and reduce the recurrence rate. 12,13 A recent retrospective study found that cyclosporine effectively treated children with refractory ITP and prevented splenectomy. 14 Given the pivotal role of cyclosporine as a potent therapy for the treatment of ITP, we conducted a systematic review and meta-analysis of published data to verify the efficacy and safety of cyclosporine in ITP treatment.…”

Research progress on serological indices and their clinical application in rheumatoid arthritis

“…The complement levels in patients with RA remain controversial, with C3 and C4 levels generally elevated. However, some studies have exhibited that C3 and C4 levels are reduced 4 …”