CLL and ITP

[Guest guest]

Yes, this is . I am no expert, but here is some

info:

From

http://www.uptodate.com/topics/abstrcts/abstrx47/88264.htm:

" ITP occurs in 2-3% of CLL patients, occurs in early

stage disease and may be a presenting manifestation.

Initial therapy for ITP mirrors the guidelines for

primary ITP. Initial therapy should consist of

prednisone. Seventy percent of patients respond.

Splenectomy is a reasonable second-line treatment. "

From:

http://e20.manu.edu.mk/rcgeb/tempus/Immunoglobulingenerearangements.html

" Platelet destruction in idiopathic thrombocytopenic

purpura is caused by autoantibodies directed against

platelet membrane glycoproteins, most frequently

against the glycoprotein complexes GPIIb/IIIa and/or

GPIb/IX. Recent studies have reported that these

antibodies frequently have a restricted light chain

isotype, thereby supporting a clonal origin.

Idiopathic thrombocytopenic purpura (ITP) is an

autoimmune disease characterized by decreased survival

of platelets due to autoantibodies. The symptoms and

signs of ITP are not specific, and may occur in

thrombocytopenia caused by other immune and nonimmune

disease like SLE, chronic lymphoproliferative diseases

like chronic lymphocytic leukemia (CLL).

[CLL] is characterized by the preferential expression

of particular Ig VH genes, and the frequent

development of autoantibodies, which are almost

exclusively directed against their own blood cells.

The most common autoimmune disorder in CLL is

autoimmune hemolytic anemia, which develops in about

7-12% of patients, but the incidence of autoantibodies

is even higher. Autoimmune thrombocytopenic purpura

occurs at lower frequencies of around 2%. It is likely

that the prevalence of anti-platelet autoantibodies

is even higher, however this issue has not been yet

investigated... "

From

http://www.medinfo.ufl.edu/pa/chuck/fall/hem_onc/bleeding.htm

" Ethanol and thiazide diuretics are known to suppress

platelet production. "

From the CLL FAQs

http://www.acor.org/leukemia/cll/cllfaq/answers/51.html

Idiopathic thrombocytopenic purpura or immune

thrombocytopenic purpura is an autoimmune disease.

These are a class of diseases where the body considers

a normal part of itself foreign (in this case

platelets), and it attacks the " foreign cells " . In

ITP, the platelets are " coated " by antibodies and the

spleen recognizes this as something to be removed from

circulation. As a result, these platelets are trapped

in the spleen until they die and are recycled. The

problem is that the body keeps making the antibody so

a replacement generation of platelets also gets

coated, and the cycle continues.

Thrombocytopenia means low platelets, and purpura

refers to the purple looking spots and bruises that

appear under the skin and mucous membranes (petechiae

and ecchymoses). So, ITP is a bruising that is caused

by low platelets which are the result of an immune

dysfunction.

Some cases of ITP are caused by drugs and others are

associated with infection, pregnancy, or immune

disorders. About half of all cases are classified as

" idiopathic " meaning the cause is unknown.

Approximately 2-4% of CLL patients develop ITP. It can

occur at any stage of CLL.

The main symptom of ITP is bleeding which can include

bruising and tiny red dots on the skin or mucous

membranes. In some instances bleeding from the nose,

gums, digestive or urinary tracts may also occur. ITP

is often accompanied by fatigue and sometimes by

depression.

ITP is characterized more by its description than the

specific properties of the disease. It is the

diagnosis when platelets are abnormally low and other

diseases that can cause low platelets have been ruled

out. The diagnosis of ITP is supported when a complete

blood count and bone marrow biopsy or aspirate finds

normal or increased platelet forming cells

(megakaryocytes).

Treatment is based on symptoms. In some cases no

treatment is needed. In most cases, corticosteroids,

such as prednisone, are the first line of treatment

because corticosteroids prevent antibody formation.

Intravenous infusions of immunoglobulin (IVIg) may be

used as the next line of treatment. Splenectomy is

successful in about 75% of patients who have not

responded to other therapy. While it may seem overly

aggressive to remove the spleen, many people think

that it is the spleen that is actually causing the

problem through over zealous removal of the platelets.

These platelets can and do work just as well as

uncoated platelets, so removing the spleen allows them

to live a " normal " lifespan and work as they should.

Other drugs used with refractory ITP include

cyclosporine, vincristine, danazol, and azathioprine

(imuran).

--- e.lynch2@... wrote:

> , Hi, I hope this is you. Can you help me find

>

> more info about folks such as myself who have ITP

> and

> CLL with no prior treatment (chemo). I keep

> searching

> but info is so limited (and so are researched

> treatment

> options). I'm feeling like a minority within a

> minority. PLEASE HELP!!!

> Estelle Lynch

> age 43 dx'd 9/99

> CLL/ITP and prednisoned out!

>

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