Advances in the Treatment of Glucocorticoid Resistance and Relapsed Immune Thrombocytopenia --Review / 中国实验血液学杂志

Immune thrombocytopenia (ITP) is an immune-mediated acquired hemorrhagic autoimmune disease. At present, the first-line therapeutic drugs for ITP include glucocorticoids and intravenous immunoglobulins. However, about 1/3 of the patients had no response to the first-line treatment, or relapsed after dose reduction or withdrawal of glucocorticoids. In recent years, with the gradual deepening of the understanding on the pathogenesis of ITP, the drugs targeting different pathogenesis continually emerge, including immunomodulators, demethylating agents, spleen tyrosine kinase (SYK) inhibitors and neonatal Fc receptor (FcRn) antagonist. However, most of these drugs are in clinical trials. This review summarized briefly the recent advances in the treatment of glucocorticoids resistance and relapsed ITP, so as to provide reference for the clinical treatments.

Development of epigenetic treatment in myelodysplastic syndromes / 白血病·淋巴瘤

It have been known that many epigenetic alterations palyed an important role in development of myelodysplastic syndromes (MDS). In contrast to genetic alterations, epigenetic alterations could be in principle pharmacologically reversed. Application of epigenetic drugs can reactivate inactivated suppressor genes. Epigenetic drugs mainly include demethylating agents and histone deacylase (HDAC) inhibitors, which are available in treatment. 5-AZA and decitabine as DNA demethylation agents have been approved by FDAof treatment in intermediate or high risk MDS, especially those old patients who are resistant to chemotherapy.HDAC inhibitors such as valproic acid are mostly employed in phase I trial, probably effective in treating low risk MDS, but treatment schedules and curative effects still have to be evaluated. The combination of demethylation agents and HDAC inhibitors may result in synergistic activity, but its therapeutic effect seems not to be superior to monotherapy of demethylation agents in current clinical trials, and it still need new clinical trials containing more cases and rational treatment schedules to identify safety and effect of combination.