A 'profound' success in treating children and young adults with rare blood disorders

October 26, 2015

Hematology researchers have safely and effectively treated children and young adults for autoimmune blood disorders in a multicenter clinical trial. In children with one of those conditions, autoimmune lymphoproliferative syndrome (ALPS), all the patients showed a durable, complete response, with normal blood cell counts and rapid improvements, a result the study team called "profound."

"Patients with ALPS and similar autoimmune disorders have had few long-term treatment options for managing their disease," said study leader David T. Teachey, M.D., a physician-researcher in hematology and oncology at The Children's Hospital of Philadelphia (CHOP). "The immunosuppressive drug we used, sirolimus, is effective and well-tolerated, with very few side effects."

The study appears online today in Blood. Karen Bride, M.D., Ph.D., from CHOP is the first author. Collaborators from 15 medical centers contributed to the research; Teachey and Bride had study co-authors from four institutions.

ALPS is one of the autoimmune cytopenias, a group of diseases in which the immune system inappropriately destroys blood cells. Patients may suffer anemia, uncontrolled bleeding and vulnerability to infections. Parents often see their children struggle with swollen lymph nodes, painful enlarged spleens, fatigue and anxiety. Because autoimmune cytopenias are relatively rare, families often experience a "diagnostic odyssey"--years of testing, bleeding and unsuccessful treatments before receiving an accurate diagnosis.

Conventional treatment for autoimmune cytopenias uses corticosteroids to suppress the immune system. However, some patients cannot tolerate these drugs, or develop resistance. Moreover, over the long term, corticosteroids increase the risk of osteoporosis and vulnerability to infection.

The current study builds on preliminary results published by Teachey and colleagues in 2009, showing sirolimus successfully treated a small cohort of five children with ALPS. Most were treated at CHOP, which has one of the world's largest clinical programs for ALPS patients.

In the current study, the first prospective multicenter trial of sirolimus in patients with refractory autoimmune cytopenias, there were 30 participants, ranging in age from five to 19 years old. Twelve patients had ALPS, six had other autoimmune cytopenias, and 12 others had secondary cytopenias caused by other underlying autoimmune diseases. All were intolerant of or resistant to corticosteroids.

Of the 12 children with ALPS, 11 had complete responses--normal blood cell counts--from one to three months after receiving sirolimus, with the 12th patient having a complete response after 18 months. Patients also had improvements in spleen and lymph node abnormalities. All 12 patients were able to discontinue steroids and other drugs within one to three months after receiving sirolimus. Over a median follow-up of two years, there were few adverse side effects, primarily mucositis--an inflammation of the mucous membranes.

The majority of the patients with non-ALPS, secondary autoimmune cytopenias (8 out of 12), also had complete responses, although later than for ALPS patients. The six patients with other autoimmune cytopenias had less robust results--one complete response and two partial responses.

Sirolimus, an immunosuppressant also known as rapamycin, has long been used to prevent rejection after a solid organ transplant. Based on the new findings, the study team recommended that doctors should consider using sirolimus early in the management of patients with autoimmune blood disorders that require ongoing treatment. In addition, said Teachey, further studies should investigate whether sirolimus can be discontinued after patients achieve a complete response.

He added that because many ALPS cases result from underlying gene mutations, future studies could also test whether sirolimus can treat other ALPS-like disorders with mutations in similar genes.

"More research remains to be done, but this treatment has produced profound, dramatic results for children, and has improved their quality of life," said Teachey.
-end-
Funding for this study came from the Partnership for Cures Patient Impact Initiative, as well as from the United States Immunodeficiency Network, through the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health (grants N01-AI30070, AI091791, AI099301). Other funders were the Goldman Philanthropic Partnerships, the Rockefeller Brothers Fund, the Barbara Brodsky Foundation and a Foerderer-Murray Award. In addition to his CHOP position, Teachey is on the faculty of the Perelman School of Medicine at the University of Pennsylvania.

"Sirolimus is effective in relapsed/refractory autoimmune cytopenias: results of a prospective multi-institutional trial," Blood, published online Oct. 26, 2015.

About The Children's Hospital of Philadelphia: The Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. In addition, its unique family-centered care and public service programs have brought the 535-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu.

Children's Hospital of Philadelphia

Related Immune System Articles from Brightsurf:

How the immune system remembers viruses
For a person to acquire immunity to a disease, T cells must develop into memory cells after contact with the pathogen.

How does the immune system develop in the first days of life?
Researchers highlight the anti-inflammatory response taking place after birth and designed to shield the newborn from infection.

Memory training for the immune system
The immune system will memorize the pathogen after an infection and can therefore react promptly after reinfection with the same pathogen.

Immune system may have another job -- combatting depression
An inflammatory autoimmune response within the central nervous system similar to one linked to neurodegenerative diseases such as multiple sclerosis (MS) has also been found in the spinal fluid of healthy people, according to a new Yale-led study comparing immune system cells in the spinal fluid of MS patients and healthy subjects.

COVID-19: Immune system derails
Contrary to what has been generally assumed so far, a severe course of COVID-19 does not solely result in a strong immune reaction - rather, the immune response is caught in a continuous loop of activation and inhibition.

Immune cell steroids help tumours suppress the immune system, offering new drug targets
Tumours found to evade the immune system by telling immune cells to produce immunosuppressive steroids.

Immune system -- Knocked off balance
Instead of protecting us, the immune system can sometimes go awry, as in the case of autoimmune diseases and allergies.

Too much salt weakens the immune system
A high-salt diet is not only bad for one's blood pressure, but also for the immune system.

Parkinson's and the immune system
Mutations in the Parkin gene are a common cause of hereditary forms of Parkinson's disease.

How an immune system regulator shifts the balance of immune cells
Researchers have provided new insight on the role of cyclic AMP (cAMP) in regulating the immune response.

Read More: Immune System News and Immune System Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.