Prospective Evaluation of Diagnosis and Treatment of Patients With Autoimmune Cytopenias Including Autoimmune Hemolytic Anemia, Immune Thrombocytopenia, and Chronic Idiopathic/Autoimmune Neutropenia

NCT ID: NCT05931718

Last Updated: 2024-10-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Total Enrollment

200 participants

Study Classification

OBSERVATIONAL

Study Start Date

2019-06-01

Study Completion Date

2035-06-30

Brief Summary

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The goal of this observational study is to characterize the diagnostic and therapeutic management of autoimmune cytopenias including autoimmune hemolytic anemia, immune thrombocytopenia, and chronic idiopathic/autoimmune neutropenia.

The main aims to answer are:

* evaluation of traditional and novel diagnostic tools including immunohematology, cytokine essays, bone marrow studies, molecular findings, and fecal microbiome.
* evaluation of type and sequence of the therapies administered, the response rates, and the adverse events.
* evaluation of clinical and laboratory (immunologic, molecular, and morphologic) predictors of outcome.
* evolution of autoimmune cytopenias into myelodysplastic syndromes.
* a subgroup of patients with myelodysplastic syndromes will be included to evaluate the presence of immunologic events, autoimmune activation, and red cell metabolism.

Participants will receive a clinical/laboratory diagnostic workup as per current clinical practice. Furthermore They will be sampled at baseline (peripheral blood and feces for microbiome) and followed up for at least 3 years to evaluate their clinical course, therapeutic management and outcome.

Detailed Description

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This observational study will characterize the diagnostic and therapeutic management of autoimmune cytopenias including autoimmune hemolytic anemia, immune thrombocytopenia, and chronic idiopathic/autoimmune neutropenia to evaluate predictors of outcome. Additionally, a subgroup of patients with myelodysplastic syndromes (diagnosed according to current WHO 5th edition 2022) will be included to evaluate the presence of autoimmune activation, and red cell metabolism.

Conditions

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Autoimmune Hemolytic Anemia Immune Thrombocytopenia Chronic Idiopathic Neutropenia Autoimmune Neutropenia Myelodysplastic Syndromes Cold Agglutinin Disease

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Autoimmune hemolytic anemia

AIHA patients will be enrolled at diagnosis and stratified according to AIHA type (i.e. warm, cold, mixed, and atypical forms), sampled for peripheral blood for cytokine and NGS studies, and for feces for microbiome studies. If clinically indicated, bone marrow evaluation will be performed and a sample for single cell analysis will be collected. Patients will be followed up to collect treatments, responses, relapses, and complications (particularly thromboses and infections).

cytokine essays

Intervention Type BIOLOGICAL

evaluation of immunomodulatory cytokines by ELISA kits on peripheral blood samples

NGS

Intervention Type BIOLOGICAL

evaluation of somatic mutations commonly associated with myeloid neoplasm and immunodeficiencies by next generation sequencing on peripheral blood samples

Fecal microbiome

Intervention Type BIOLOGICAL

evaluation of fecal microbiome on fecal samples

Erythropoietin

Intervention Type DRUG

evaluation of recombinant erythropoietin use, safety and efficacy in patients with autoimmune hemolytic anemia according to clinical practice

Immune thrombocytopenia

ITP patients will be enrolled at diagnosis and sampled for peripheral blood for cytokine and NGS studies, and for feces for microbiome studies. If clinically indicated, bone marrow evaluation will be performed and a sample for single cell analysis will be collected.Patients will be followed up to collect treatments, responses, relapses, and complications (particularly thromboses and infections).

cytokine essays

Intervention Type BIOLOGICAL

evaluation of immunomodulatory cytokines by ELISA kits on peripheral blood samples

NGS

Intervention Type BIOLOGICAL

evaluation of somatic mutations commonly associated with myeloid neoplasm and immunodeficiencies by next generation sequencing on peripheral blood samples

Fecal microbiome

Intervention Type BIOLOGICAL

evaluation of fecal microbiome on fecal samples

Thrombopoietin Receptor Agonist

Intervention Type DRUG

evaluation of TPO-RA use, safety and efficacy in patients with ITP according to clinical practice

Chronic idiopathic neutropenia/Autoimmune neutropenia

CIN/AIN patients will be enrolled at diagnosis and sampled for peripheral blood for cytokine and NGS studies, and for feces for microbiome studies. If clinically indicated, bone marrow evaluation will be performed and a sample for single cell analysis will be collected.Patients will be followed up to collect treatments, responses, relapses, and complications (particularly infections).

cytokine essays

Intervention Type BIOLOGICAL

evaluation of immunomodulatory cytokines by ELISA kits on peripheral blood samples

NGS

Intervention Type BIOLOGICAL

evaluation of somatic mutations commonly associated with myeloid neoplasm and immunodeficiencies by next generation sequencing on peripheral blood samples

Fecal microbiome

Intervention Type BIOLOGICAL

evaluation of fecal microbiome on fecal samples

G-CSF

Intervention Type DRUG

evaluation of G-CSF use, safety and efficacy in patients with CIN/AIN according to clinical practice

Myelodysplastic syndromes

MDS patients will be enrolled at diagnosis and sampled for peripheral blood for cytokine and NGS studies, and to evaluate red cell metabolism. If clinically indicated, bone marrow evaluation will be performed and a sample for single cell analysis will be collected. Patients will be followed up to collect treatments, responses, relapses, and outcome.

cytokine essays

Intervention Type BIOLOGICAL

evaluation of immunomodulatory cytokines by ELISA kits on peripheral blood samples

NGS

Intervention Type BIOLOGICAL

evaluation of somatic mutations commonly associated with myeloid neoplasm and immunodeficiencies by next generation sequencing on peripheral blood samples

Fecal microbiome

Intervention Type BIOLOGICAL

evaluation of fecal microbiome on fecal samples

Luspatercept

Intervention Type DRUG

evaluation of cytokine levels, molecular profile and bone marrow microenvironment by single cell analysis in patients treated with luspatercept according to clinical practice

Interventions

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cytokine essays

evaluation of immunomodulatory cytokines by ELISA kits on peripheral blood samples

Intervention Type BIOLOGICAL

NGS

evaluation of somatic mutations commonly associated with myeloid neoplasm and immunodeficiencies by next generation sequencing on peripheral blood samples

Intervention Type BIOLOGICAL

Fecal microbiome

evaluation of fecal microbiome on fecal samples

Intervention Type BIOLOGICAL

Erythropoietin

evaluation of recombinant erythropoietin use, safety and efficacy in patients with autoimmune hemolytic anemia according to clinical practice

Intervention Type DRUG

Luspatercept

evaluation of cytokine levels, molecular profile and bone marrow microenvironment by single cell analysis in patients treated with luspatercept according to clinical practice

Intervention Type DRUG

Thrombopoietin Receptor Agonist

evaluation of TPO-RA use, safety and efficacy in patients with ITP according to clinical practice

Intervention Type DRUG

G-CSF

evaluation of G-CSF use, safety and efficacy in patients with CIN/AIN according to clinical practice

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Diagnosis of autoimmune cytopenias (AIHA/ITP/CIN/AIN)
* age \>/= 18 years
* ability to sign informed consent
* availability to undergo 3 year follow up
* for the subgroup of patients with myelodysplastic syndrome: bone marrow evaluation showing \>/= 10% dysplastic features of at least one lineage along with MDS defining cytopenia and/or MDS defining cytogenetics.

Exclusion Criteria

* any condition impeding the acquisition of the informed consent
* immune cytopenia diagnosis preceding \>/= 6 months the enrolment
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico

Milan, , Italy

Site Status RECRUITING

Countries

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Italy

Facility Contacts

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Bruno Fattizzo, MD

Role: primary

+390255033477

References

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Fattizzo B, Pedone GL, Brambilla C, Pettine L, Zaninoni A, Passamonti F, Barcellini W. Recombinant erythropoietin in autoimmune hemolytic anemia with inadequate bone marrow response: a prospective analysis. Blood Adv. 2024 Mar 12;8(5):1322-1327. doi: 10.1182/bloodadvances.2023011798.

Reference Type DERIVED
PMID: 38029356 (View on PubMed)

Versino F, Revelli N, Villa S, Pettine L, Zaninoni A, Prati D, Passamonti F, Barcellini W, Fattizzo B. Transfusions in autoimmune hemolytic anemias: Frequency and clinical significance of alloimmunization. J Intern Med. 2024 Mar;295(3):369-374. doi: 10.1111/joim.13753. Epub 2023 Nov 27.

Reference Type DERIVED
PMID: 38013593 (View on PubMed)

Other Identifiers

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CYTOPAN

Identifier Type: -

Identifier Source: org_study_id

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