Refractory immune thrombocytopenic purpura associated with IgM monoclonal gammopathy of undetermined significance: Successful treatment with tirabrutinib plus conventional therapies

Ryosuke Naka; Hitomi Kaneko; Osamu Nagata; Kohei Tada; Masaharu Tashima; Chisato Mizutani; Kazunori Imada

doi:10.1002/jha2.423

Refractory immune thrombocytopenic purpura associated with IgM monoclonal gammopathy of undetermined significance: Successful treatment with tirabrutinib plus conventional therapies

EJHaem. 2022 Mar 17;3(2):513-516. doi: 10.1002/jha2.423. eCollection 2022 May.

Authors

Ryosuke Naka¹, Hitomi Kaneko¹, Osamu Nagata¹, Kohei Tada¹, Masaharu Tashima¹, Chisato Mizutani¹, Kazunori Imada¹

Affiliation

¹ Department of Hematology Japanese Red Cross Osaka Hospital Osaka Japan.

Abstract

When immune thrombocytopenia (ITP) is secondary to malignant diseases, chemotherapy is expected to improve the platelet count (PC) as well. Herein, we report a case of a 72-year-old man with ITP refractory to standard therapies. IgM monoclonal gammopathy of undetermined significance (MGUS) was determined as an underlying disease. After bendamustine and rituximab (BR) therapy was found inadequately effective, tirabrutinib, a novel Bruton's tyrosine kinase inhibitor, was initiated, and the PC normalised subsequently. Surveillance of underlying diseases with which effective therapies are available may help manage refractory ITP, and IgM-MGUS is potentially a targetable underlying disease with this newly available drug.

Keywords: IgM‐MGUS; refractory ITP; tirabrutinib.