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Treatment of paroxysmal nocturnal hemoglobinuria

https://doi.org/10.17650/1818-8346-2012-7-3-49-54

Abstract

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, life‑threatening clonal hematological disorder caused by an acquired mutation in the phosphatidylinositol glucan (PIG)-A gene. PNH is characterized by chronic intravascular hemolysis, marrow failure, thrombophilia and other severe clinical syndromes. Until recently, the treatment of PNH has been symptomatic with blood transfusions, anticoagulation and supplementation with folic acid or iron. The only potentially curative treatment is allogeneic stem cell transplantation, but this has severe complications with high mortality rates. A new targeted treatment strategy is the inhibition of the terminal complement cascade with anti‑C5 monoclonal antibody (eculizumab). Eculizumab has shown significant efficacy in controlling of intravascular hemolysis resulting in improving quality of life and survival.

About the Authors

I. A. Lisukov
Raisa Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University of St.-Petersburg, Ministry of Health of Russia
Russian Federation


A. D. Kulagin
Raisa Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University of St.-Petersburg, Ministry of Health of Russia
Russian Federation


B. V. Afanasyev
Raisa Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University of St.-Petersburg, Ministry of Health of Russia
Russian Federation


References

1. Rosse W.F., Ware R.E. The molecular basis of paroxysmal nocturnal hemoglobinuria. Blood 1995;86(9):3277−86.

2. Rother R., Bell L., Hillmen P. et al. The clinical sequealae of intravascular hemolysis and extracellular plasma hemoglobin. JAMA 2005;293(13):1653−62.

3. Beutler E., Luzzatto L. Hemolytic anemia. Semin Hematol 1999;36(suppl 7): 38−47.

4. Johnson R., Hillmen P. Paroxysmal nocturnal haemoglobinuria: Nature’s gene therapy? J Clin Pathol: Mol Pathol 2002;55(3):145−52.

5. Young N., Maciejewski J. Genetic and environmental effects in paroxysmal nocturnal hemoglobinuria: this little PIG‑A goes “Why? Why? Why?” J Clin Invest 2000;106(5):637−41.

6. Гаврилов О.К., Файнштейн Ф.Э., Турбина Н.С. Депрессии кроветворения. М.: Медицина, 1987. 256 c.

7. Crosby W. Paroxysmal nocturnal hemoglobinuria: a classic description by Paul Strübing in 1882, and a bibliography of the disease. Blood 1951;6:270−84.

8. Lewis S., Dacie J. The aplastic anemia: paroxysmal nocturnal hemoglobinuria syndrome. Br J Haematol 1967;13:236−51.

9. Socie G., Mary J., de Gramont A. et al. Paroxysmal nocturnal haemoglobinuria: long term follow‑up and prognostic factors. French Society of Haematology. Lancet 1996;348:573−7.

10. Hillmen P., Lewis S., Bessler M. et al. Natural history of paroxysmal nocturnal hemoglobinuria. N Engl J Med 1995; 333:1253−9.

11. Parker C., Omine M., Richards S. et al. Diagnosis and management of paroxysmal nocturnal hemoglobinuria. Blood 2005; 106(12):3699−709.

12. Hillmen P., Hall C., Marsh J. et al. Effect of eculizumab on hemolysis and transfusion requirements in patients with paroxysmal nocturnal hemoglobinuria. N Engl J Med 2004;350(6):552−9.

13. Hillmen P., Young N., Schubert J. et al. The complement inhibitor eculizumab in paroxysmal nocturnal hemoglobinuria. N Engl J Med 2006;355(12):1233−43.

14. Kelly R., Hill A., Arnold L. et al. Long‑term treatment with eculizumab in paroxysmal nocturnal hemoglobinuria: sustained efficacy and improved survival. Blood 2011;117:6786−92.

15. Young N., Antonioli E., Rotoli B. et al. Safety and efficacy of the terminal complement inhibitor eculizumab in patients with paroxysmal nocturnal hemoglobinuria: Interim Shepherd Phase III Clinical Study. Blood 2006;108:971.

16. Hillmen P., Muus P., Duhrsen U. et al. Effect of the complement inhibitor eculizumab n thrombembolizm n patients with paroxysmal nocturnal hemoglobinuria. Blood 2007;110:4123−8.

17. Hall C., Richards S., Hillmen P. Primary prophylaxis with warfarin prevents thrombosis in paroxysmal nocturnal hemoglobinuria (PNH). Blood 2003; 102:4587−91.

18. Hillmen P., Elebute M., Kelly R. Long‑term effect of the complement inhibitor eculizumab on kidney function in patients with paroxysmal nocturnal hemoglobinuria. Am J Hematol 2010; 85(8):553−9.

19. Brodsky R., de Castro C., Schrezenmeier H. Long term safety and efficacy of sustained eculizumab treatment in patients with paroxysmal nocturnal hemoglobinuria (PNH). Blood 2010;116(21):abstr. 4237.

20. Gladwin M., Sachdev V., Jison M. et al. Pulmonary hypertension as a risk factor for death in patients with sickle cell disease. N Engl J Med 2004;350(9):886−95.

21. Hill A., Rother R., Wang X. et al. Effect of eculizumab on haemolysis-associated nitric oxide depletion, dyspnoea, and measures of pulmonary hypertension in patients with paroxysmal nocturnal haemoglobinuria. Br J Haematol 2010; 149(3):414−25.

22. Arnold L., Brooksbank G., Kelly R. et al. Continued benefit from prolonged treatment with eculizumab in 130 patients with PNH in the UK: home delivery of eculizumab is safe, convenient and associated with very high levels of patients satisfaction. Blood 2011; 118(21):abstr. 4368.

23. Sah A., Ridley S., Richards S. et al. Prodaptin‑CD59, a membrane-targeted recombinant CD59, coats PNH red cells in vitro and in vivo protecting both from human complement mediated lyses. Hematology J 2004;5(suppl. 2):207.

24. Brecher M., Taswell H. Paroxysmal nocturnal hemoglobinuria and the transfusion of washed red cells: a myth revised. Transfusion 1989;29 :681−5.

25. Hill A., Rother R., Hillmen P. Improvement in the symptoms of smooth muscle dystonia during eculizumab therapy in paroxysmal nocturnal hemoglobinuria. Haematologica 2005;90(online):111−3.

26. Hegenbart U., Niederwieser D., Forman S. et al. Hematopoietic cell transplantation from related and unrelated donors after minimal conditioning as a curative treatment modality for severe paroxysmal nocturnal hemoglobinuria. Biol Blood Marrow Transplant 2003; 9(11):689−97.

27. De Latour R., Schrezenmeier H., Bacigalupo A. et al. Allogeneic hematopoietic stem cell transplantation in paroxysmal nocturnal hemoglobinuria: a transplant versus no transplant matched comparison study n behalf of the severe aplastic anemia working party (SAAWP) of the European group for blood and marrow transplantation (EBMT) Group and the French Society of Hematology (SFH). Blood 2011;118(21):abstr. 2403.

28. Paquette R., Yoshimura R., Veiseh C. et al. Clinical characteristics predict response to antithymocyte globulin in paroxysmal nocturnal haemoglobinuria. Br J Haematol 1997;96(1):92−7.

29. Sugimori C., Chuhjo T., Feng X. et al. Minor population of CD55-CD59-blood cells predicts response to immunosuppressive therapy and prognosis in patients with aplastic anemia. Blood 2006;107(4):1308−14.

30. Wang H., Chuhjo T., Yasue S., Omine M., Nakao S. Clinical significance of a minor population of paroxysmal nocturnal hemoglobinuria-type cells in bone marrow failure syndrome. Blood 2002;100(12):3897−902.

31. Kulagin A, Golubovskaya I., Ganapiev B. et al. Prognostic value of minor PNH clones in aplastic anemia treated with ATG‑based immunosuppression: Results of two‑center prospective study. Bone Marrow Transplantation 2011;46(Suppl 1):83.

32. Tran M., Fadeyi E., Scheinberg P., Klein H. Apparent hemolysis following intravenous antithymocyte globulin treatment in a patient with marrow failure and a paroxysmal nocturnal hemoglobinuria clone. Transfusion 2006;46(7):1244−7.

33. Van Kamp H., van Imhoff G., de Wolf J. et al. The effect of cyclosporine on haematological parameters in patients with paroxysmal nocturnal haemoglobinuria. Br J Haematol 1995;89:79−82.

34. Лисуков И.А., Крючкова И.В., Кулагин А.Д., Гилевич А.В. Клинический случай пароксизмальной ночной гемоглобинурии с ответом на терапию циклоспорином А. Гематол и трансфузиол 1998; 43(5):46.

35. Масчан А.А., Богачева Н.Ю., Байдун Л.В. и др. Синдром пароксизмальной ночной гемоглобинурии у детей с приобретенной апластической анемией. Гематол и трансфузиол 1996;41(3):20−5.


Review

For citations:


Lisukov I.A., Kulagin A.D., Afanasyev B.V. Treatment of paroxysmal nocturnal hemoglobinuria. Oncohematology. 2012;7(3):49-54. (In Russ.) https://doi.org/10.17650/1818-8346-2012-7-3-49-54

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ISSN 1818-8346 (Print)
ISSN 2413-4023 (Online)