A review of the management of childhood immune thrombocytopenia: How can we provide an evidence-based approach?

British Journal of Haematology

Volumn 165, Issue 6, 2014, Pages 756-767

  Cooper, Nichola ^a  

^a HAMMERSMITH HOSPITAL   (United Kingdom)

Author keywords

Paediatric immune thrombocytopenia; Rituximab; Splenectomy; Thrombocytopenia; Thrombopoietin

Indexed keywords

ELTROMBOPAG; IMMUNOSUPPRESSIVE AGENT; PLACEBO; RECOMBINANT BLOOD CLOTTING FACTOR 7A; RITUXIMAB; ROMIPLOSTIM; STEROID; TRANEXAMIC ACID;

AUTOIMMUNE THROMBOCYTOPENIA; BLEEDING; BONE MARROW EXAMINATION; BRAIN HEMORRHAGE; CHILDHOOD DISEASE; CLINICAL ASSESSMENT; DISEASE DURATION; DRUG EFFECT; DRUG EFFICACY; DRUG SAFETY; EPISTAXIS; EVIDENCE BASED PRACTICE; FATIGUE; HEADACHE; HELICOBACTER PYLORI; HUMAN; IMMUNOSUPPRESSIVE TREATMENT; IRRITABILITY; MEDICAL DECISION MAKING; MORBIDITY; NONHUMAN; OUTCOME ASSESSMENT; PRIORITY JOURNAL; QUALITY OF LIFE; REVIEW; RISK ASSESSMENT; SPLENECTOMY; THROMBOCYTOPENIA; TREATMENT PLANNING;

PAEDIATRIC IMMUNE THROMBOCYTOPENIA; RITUXIMAB; SPLENECTOMY; THROMBOCYTOPENIA; THROMBOPOIETIN;

CHILD; CHILD, PRESCHOOL; EVIDENCE-BASED MEDICINE; HEMORRHAGE; HUMANS; PURPURA, THROMBOCYTOPENIC, IDIOPATHIC; THROMBOCYTOPENIA;

EID: 84901694771     PISSN: 00071048     EISSN: 13652141     Source Type: Journal    
DOI: 10.1111/bjh.12889     Document Type: Review

References (76)

1. Belletrutti, M., Ali, K., Barnard, D., Blanchette, V., Chan, A., David, M., Luke, B., Price, V., Ritchie, B. & Wu, J.; Canadian Pediatric Chronic ITP Working Group; Canadian Pediatric Thrombosis and Hemostasis Network. (2007) Chronic immune thrombocytopenic purpura in children: a survey of the Canadian experience. Journal of Pediatric Hematology and Oncology, 29, 95-100.
2. Ben-Yehuda, D., Gillis, S. & Eldor, A.; Israeli ITP Study Group. (1994) Clinical and therapeutic experience in 712 Israeli patients with idiopathic thrombocytopenic purpura. Acta Haematologica, 91, 1-6.
3. Blanchette, V.S., Kirby, M.A. & Turner, C. (1992) Role of intravenous immunoglobulin G in autoimmune hematologic disorders. Seminars in Hematology, 29(3 Suppl. 2), 72-82.
4. Blatt, J., Weston, B. & Gold, S. (2010) Fatigue as marker of thrombocytopenia in childhood idiopathic thrombocytopenic purpura. Pediatric Hematology and Oncology, 27, 65-67.
5. Boiocchi, L., Orazi, A., Ghanima, W., Arabadjief, M., Bussel, J.B. & Geyer, J.T. (2012) Thrombopoietin receptor agonist therapy in primary immune thrombocytopenia is associated with bone marrow hypercellularity and mild reticulin fibrosis but not other stromal abnormalities. Modern Pathology, 25, 65-74.
6. Boyle, S., White, R.H., Brunson, A. & Wun, T. (2013) Splenectomy and the incidence of venous thromboembolism and sepsis in patients with immune thrombocytopenia. Blood, 121, 4782-4790.
7. Breakey, V.R. & Blanchette, V.S. (2011) Childhood immune thrombocytopenia: a changing therapeutic landscape. Seminars in Thrombosis and Hemostasis, 37, 745-755.
8. British Committee for Standards in Haematology General Haematology Task Force. (2003) Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. British Journal of Haematology, 120, 574-596.
9. Bryant, N. & Watts, R. (2011) Thrombocytopenic syndromes masquerading as childhood immune thrombocytopenic purpura. Clinical Pediatrics, 50, 225-230.
10. Bussel, J.B., Kuter, D.J., George, J.N., McMillan, R., Aledort, L.M., Conklin, G.T., Lichtin, A.E., Lyons, R.M., Nieva, J., Wasser, J.S., Wiznitzer, I., Kelly, R., Chen, C.F. & Nichol, J.L. (2006) AMG 531, a thrombopoiesis-stimulating protein, for chronic ITP. New England Journal of Medicine, 355, 1672-1681.
11. Bussel, J.B., Kuter, D.J., Pullarkat, V., Lyons, R.M., Guo, M. & Nichol, J.L. (2009) Safety and efficacy of long-term treatment with romiplostim in thrombocytopenic patients with chronic ITP. Blood, 113, 2161-2171.
12. Bussel, J.B., Buchanan, G.R., Nugent, D.J., Gnarra, D.J., Bomgaars, L.R., Blanchette, V.S., Wang, Y.M., Nie, K. & Jun, S. (2011) A randomized, double-blind study of romiplostim to determine its safety and efficacy in children with immune thrombocytopenia. Blood, 118, 28-36.
13. Calpin, C., Dick, P., Poon, A. & Feldman, W. (1998) Is bone marrow aspiration needed in acute childhood idiopathic thrombocytopenic purpura to rule out leukemia? Archives of Pediatric Adolescent Medicine, 152, 345-347.
14. Carcao, M.D., Zipursky, A., Butchart, S., Leaker, M. & Blanchette, V.S. (1998) Short-course oral prednisone therapy in children presenting with acute immune thrombocytopenic purpura (ITP). Acta Paediatric Supplement, 424, 71-74.
15. Carson, K.R., Evens, A.M., Richey, E.A., Habermann, T.M., Focosi, D., Seymour, J.F., Laubach, J., Bawn, S.D., Gordon, L.I., Winter, J.N., Furman, R.R., Vose, J.M., Zelenetz, A.D., Mamtani, R., Raisch, D.W., Dorshimer, G.W., Rosen, S.T., Muro, K., Gottardi-Littell, N.R., Talley, R.L., Sartor, O., Green, D., Major, E.O. & Bennett, C.L. (2009) Progressive multifocal leukoencephalopathy after rituximab therapy in HIV-negative patients: a report of 57 cases from the research on adverse drug events and reports project. Blood, 113, 4834-4840.
16. Cheng, G., Tarantino, M., Gernsheimer, T., Meyer, O., Brainsky, A. & Stone, N.L. (2009) Platelet counts following eltrombopag discontinuation in patients with chronic immune thrombocytopenic purpura. Blood (ASH Annual Meeting Abstracts), 114, 3517.
17. Cheng, G., Saleh, M.N., Marcher, C., Vasey, S., Mayer, B., Aivado, M., Arning, M., Stone, N.L. & Bussel, J.B. (2011) Eltrombopag for management of chronic immune thrombocytopenia (RAISE): a 6-month, randomised, phase 3 study. Lancet, 377, 393-402.
18. Choudhary, D.R., Naithani, R., Mahapatra, M., Kumar, R., Mishra, P. & Saxena, R. (2009) Intracranial hemorrhage in childhood immune thrombocytopenic purpura. Pediatric Blood Cancer, 52, 529-531.
19. Cloutier, N., Paré, A., Farndale, R.W., Schumacher, H.R., Nigrovic, P.A., Lacroix, S. & Boilard, E. (2012) Platelets can enhance vascular permeability. Blood, 120, 1334-1343.
20. Cooper, N. & Bussel, J.B. (2010) The long-term impact of rituximab for childhood immune thrombocytopenia. Current Rheumatology Reports, 12, 94-100.
21. Cooper, N., Davies, E.G. & Thrasher, A.J. (2009) Repeated courses of rituximab for autoimmune cytopenias may precipitate profound hypogammaglobulinaemia requiring replacement intravenous immunoglobulin. British Journal of Haematology, 146, 120-122.
22. Cuker, A. (2010) Toxicities of the thrombopoietic growth factors. Seminars in Hematology, 47, 289-298.
23. Cuker, A. & Cines, D.B. (2010) Evidence-based mini-review: is indium-labeled autologous platelet scanning predictive of response to splenectomy in patients with chronic immune thrombocytopenia? Hematology American Society of Hematology Education Program, 2010, 385-386 Review.
24. Del Vecchio, G.C., De Santis, A., Giordano, P., Amendola, G., Baronci, C., Del Principe, D., Nobili, B., Jankovic, M., Ramenghi, U., Russo, G., Zecca, M. & De Mattia, D.; AIEOP ITP Study Group. (2008) Management of acute childhood idiopathic thrombocytopenic purpura according to AIEOP consensus guidelines: assessment of Italian experience. Acta Haematologica, 119, 1-7.
25. Despotovic, J.M., Lambert, M.P., Herman, J.H., Gernsheimer, T.B., McCrae, K.R., Tarantino, M.D. & Bussel, J.B. (2012) RhIG for the treatment of immune thrombocytopenia: consensus and controversy (CME). Transfusion, 52, 1126-1136.
26. DiMaggio, D., Anderson, A. & Bussel, J.B. (2009) Cytomegalovirus can make immune thrombocytopenic purpura refractory. British Journal of Haematology, 146, 104-112.
27. Dubansky, A.S., Boyett, J.M., Falletta, J., Mahoney, D.H., Land, V.J., Pullen, J. & Buchanan, G. (1989) Isolated thrombocytopenia in children with acute lymphoblastic leukemia: a rare event in a Pediatric Oncology Group Study. Pediatrics, 84, 1068-1071.
28. Elalfy, M., Elbarbary, N., Khaddah, N., Abdelwahab, M., El Rashidy, F., Hassab, H. & Al-Tonbary, Y. (2010) Intracranial hemorrhage in acute and chronic childhood immune thrombocytopenic purpura over a ten-year period: an Egyptian multicenter study. Acta Haematologica, 123, 59-63.
29. Elalfy, M.S., Abdelmaksoud, A.A. & Eltonbary, K.Y. (2011) Romiplostim in children with chronic refractory ITP: randomized placebo controlled study. Annals of Hematology, 90, 1341-1344.
30. Frith, J., Watson, S., Bolton Maggs, P.H.B. & Newton, J.L. (2012) Cognitive symptoms are common in immune thrombocytopenia and associate with autonomic symptom burden. European Journal of Haematology, 88, 224-228.
31. Geddis, A. & Balduini, C.L. (2007) Diagnosis of immune thrombocytopenic purpura in children. Current Opinion in Hematology, 14, 520-525.
32. George, J.N., Woolf, S.H., Raskob, G.E., Wasser, J.S., Aledort, L.M., Ballem, P.J., Blanchette, V.S., Bussel, J.B., Cines, D.B., Kelton, J.G., Lichtin, A.E., McMillan, R., Okerbloom, J.A., Regan, D.H. & Warrier, I. (1996) Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood, 88, 3-40.
33. Ghanima, W., Geyer, J.T., Lee, C.S., Boiocchi, L., Imahiyerobo, A.A., Orazi, A. & Bussel, J.B. (2014) Bone marrow fibrosis in 66 immune thrombocytopenia patients treated with thrombopoietin receptor agonists: a single center long-term follow-up. Haematologica, doi: 10.3324/haematol.2013.09892.
34. Grainger, J.D., Rees, J.L., Reeves, M. & Bolton-Maggs, P.H. (2012) Changing trends in the UK management of childhood ITP. Archives of Disease in Childhood, 97, 8-11.
35. Halperin, D.S. & Doyle, J.J. (1988) Is bone marrow examination justified in idiopathic thrombocytopenic purpura? American Journal of Diseases of Childood, 142, 508-511.
36. Iyori, H., Bessho, F., Ookawa, H., Konishi, S., Shirahata, A., Miyazaki, S., Fujisawa, K. & Akatsuka, J. (2000) Japanese Study Group on childhood ITP. Intracranial hemorrhage in children with immune thrombocytopenic purpura. Japanese Study Group on childhood ITP. Annals of Hematology, 79, 691-695.
37. Jones, E.C. & Boyko, W.J. (1985) Diagnostic value of bone marrow examination in isolated thrombocytopenia. American Journal of Clinical Pathology, 84, 665-667.
38. Jubelirer, S.J. & Harpold, R. (2002) The role of the bone marrow examination in the diagnosis of immune thrombocytopenic purpura: case series and literature review. Clinical Applied Thrombosis and Hemostasis, 8, 73-76.
39. Kime, C., Klima, J., Rose, M.J. & O'Brien, S.H. (2013) Patterns of inpatient care for newly diagnosed immune thrombocytopenia in US children's hospitals. Pediatrics, 131, 880-885.
40. Klaassen, R.J., Blanchette, V.S., Barnard, D., Wakefield, C.D., Curtis, C., Bradley, C.S., Neufeld, E.J., Buchanan, G.R., Silva, M.P., Chan, A.K. & Young, N.L. (2007) Validity, reliability, and responsiveness of a new measure of health-related quality of life in children with immune thrombocytopenic purpura: the Kids' ITP Tools. Journal of Pediatrics, 150, 510-515.
41. Klaassen, R.J., Mathias, S.D., Buchanan, G., Bussel, J., Deuson, R., Young, N.L., Collier, A., Bomgaars, L. & Blanchette, V. (2012) Pilot study of the effect of romiplostim on child health-related quality of life (HRQoL) and parental burden in immune thrombocytopenia (ITP). Pediatric Blood Cancer, 58, 395-398.
42. Klaassen, R.J., Blanchette, V., Burke, T.A., Wakefield, C., Grainger, J.D., Gaedicke, G., Riedlinger, A., Dufort, G., Citrin, E., Reguerre, Y., Pellier, I., Curtis, C. & Young, N.L. (2013) Quality of life in childhood immune thrombocytopenia: international validation of the kids' ITP tools. Pediatric Blood Cancer, 60, 95-100.
43. Kühne, T., Blanchette, V., Buchanan, G.R., Ramenghi, U., Donato, H., Tamminga, R.Y., Rischewski, J., Berchtold, W. & Imbach, P.; Intercontinental Childhood ITP Study Group. (2007) Splenectomy in children with idiopathic thrombocytopenic purpura: a pro- spective study of 134 children from the Intercontinental Childhood ITP Study Group. Pediatric Blood Cancer, 49, 829-834.
44. Kuter, D.J., Rummel, M., Boccia, R., Macik, B.G., Pabinger, I., Selleslag, D., Rodeghiero, F., Chong, B.H., Wang, X. & Berger, D.P. (2010) Romiplostim or standard of care in patients with immune thrombocytopenia. New England Journal of Medicine, 363, 1889-1899.
45. Kuter, D.J., Bussel, J.B., Newland, A., Baker, R.I., Lyons, R.M., Wasser, J., Viallard, J.F., Macik, G., Rummel, M., Nie, K. & Jun, S. (2013) Long-term treatment with romiplostim in patients with chronic immune thrombocytopenia: safety and efficacy. British Journal of Haematology, 161, 411-423.
46. Larsen, O.H., Stentoft, J., Radia, D., Ingerslev, J. & Sørensen, B. (2013) Combination of recombinant factor VIIa and fibrinogen corrects clot formation in primary immune thrombocytopenia at very low platelet counts. British Journal of Haematology, 160, 228-236.
47. Liang, Y., Zhang, L., Gao, J., Hu, D. & Ai, Y. (2012) Rituximab for children with immune thrombocytopenia: a systematic review. PLoS One, 7, e36698.
48. Lilleyman, J.S. (1994) Intracranial haemorrhage in idiopathic thrombocytopenic purpura. Archives of Disease in Childhood, 74, 251-253.
49. Maddrey, W.C., Cheng, G., Khelif, A., Wroblewski, S.L. & Brainsky, A. (2009) Evaluation of hepatobiliary parameters during eltrombopag treatment in patients with chronic immune thrombocytopenic purpura. Blood (ASH Annual Meeting Abstracts), 114, 2410.
50. Mantadakis, E. & Buchanan, G.R. (2000) Elective splenectomy in children with idiopathic thrombocytopenic purpura. Journal of Pediatric Hematology Oncology, 22, 148-153.
51. Neunert, C.E., Buchanan, G.R., Imbach, P., Bolton-Maggs, P.H., Bennett, C.M., Neufeld, E.J., Vesely, S.K., Adix, L., Blanchette, V.S. & Kühne, T. (2008) Intercontinental Childhood ITP Study Group Registry II Participants. Severe hemorrhage in children with newly diagnosed immune thrombocytopenic purpura. Blood, 112, 4003-4008.
52. Neunert, C.E., Buchanan, G.R., Blanchette, V., Barnard, D., Young, N.L., Curtis, C. & Klaassen, R.J. (2009) Relationships among bleeding severity, health-related quality of life, and platelet count in children with immune thrombocytopenic purpura. Pediatric Blood Cancer, 53, 652-654.
53. Neunert, C., Lim, W., Crowther, M., Cohen, A., Solberg, L. Jr & Crowther, M.A.; American Society of Hematology. (2011) The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood, 117, 4190-4207.
54. Neunert, C., Buchanan, G.R., Imbach, P., Bolton-Maggs, P.H.B., Bennett, C.M., Neufeld, E., Vesely, S.K., Adix, L., Blanchette, V.S. & Kühne, T. (2013) Bleeding manifestations and management of children with persistent and chronic immune thrombocytopenia: data from the Intercontinental Cooperative ITP Study Group (ICIS). Blood, 121, 4457-4462.
55. Paling, A. & Stefan, D.C. (2008) Idiopathic thrombocytopenic purpura in childhood: a 10-year audit. Hematology, 13, 175-180.
56. Patel, V.L., Mahévas, M., Lee, S.Y., Stasi, R., Cunningham-Rundles, S., Godeau, B., Kanter, J., Neufeld, E., Taube, T., Ramenghi, U., Shenoy, S., Ward, M.J., Mihatov, N., Patel, V.L., Bierling, P., Lesser, M., Cooper, N. & Bussel, J.B. (2012) Outcomes 5 years after response to rituximab therapy in children and adults with immune thrombocytopenia. Blood, 119, 5989-5995.
57. Provan, D., Stasi, R., Newland, A.C., Blanchette, V.S., Bolton-Maggs, P., Bussel, J.B., Chong, B.H., Cines, D.B., Gernsheimer, T.B., Godeau, B., Grainger, J., Greer, I., Hunt, B.J., Imbach, P.A., Lyons, G., McMillan, R., Rodeghiero, F., Sanz, M.A., Tarantino, M., Watson, S., Young, J. & Kuter, D.J. (2010) International consensus report on the investigation and management of primary immune thrombocytopenia. Blood, 115, 168-186.
58. Psaila, B., Petrovic, A., Page, L.K., Menell, J., Schonholz, M. & Bussel, J.B. (2009) Intracranial hemorrhage (ICH) in children with immune thrombocytopenia (ITP): study of 40 cases. Blood, 114, 4777-4783.
59. Rodeghiero, F. & Ruggeri, M. (2012) Short- and long-term risks of splenectomy for benign hae-matological disorders: should we revisit the indications? British Journal of Haematology, 158, 16-29.
60. Rodeghiero, F., Stasi, R., Gernsheimer, T., Michel, M., Provan, D., Arnold, D.M., Bussel, J.B., Cines, D.B., Chong, B.H., Cooper, N., Godeau, B., Lechner, K., Mazzucconi, M.G., McMillan, R., Sanz, M.A., Imbach, P., Blanchette, V., Kühne, T., Ruggeri, M. & George, J.N. (2009) Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an International Working Group. Blood, 113, 2386-2393.
61. Rosthoj, S., Rajamtie, J., Treutiger, I., Zeller, B., Tedgard, U. & Henter, J. (2012) Duration and morbidity of chronic immune thrombocytopenic purpura in children: five-year follow-up of a Nordic cohort. Acta Paediatrica, 101, 761-766.
62. Russo, G., Miraglia, V., Branciforte, F., Matarese, S.M., Zecca, M., Bisogno, G., Parodi, E., Amendola, G., Giordano, P., Jankovic, M., Corti, A., Nardi, M., Farruggia, P., Battisti, L., Baronci, C., Palazzi, G., Tucci, F., Ceppi, S., Nobili, B., Ramenghi, U., De Mattia, D. & Notarangelo, L.; AIEOP-ITP Study Group. (2011) Effect of eradication of Helicobacter pylori in children with chronic immune thrombocytopenia: a prospective, controlled, multicenter study. Pediatric Blood Cancer, 56, 273-278.
63. Salama, A., Rieke, M., Kiesewetter, H. & von Depka, M. (2009) Experiences with recombinant FVIIa in the emergency treatment of patients with autoimmune thrombocytopenia: a review of the literature. Annals of Hematology, 88, 11-15.
64. Saleh, M.N., Bussel, J.B., Cheng, G., Meyer, O., Bailey, C.K., Arning, M. & Brainsky, A.; on behalf of the EXTEND Study Group. (2013) Safety and efficacy of eltrombopag for treatment of chronic immune thrombocytopenia: results of the long-term, open-label EXTEND study. Blood, 121, 537-545.
65. Sarpatwari, A., Watson, S., Erqou, S., Anderson, H., Grainger, J., Higgins, J.P. & Newland, A.C. (2010a) Health-related lifestyle in adults and children with primary immune thrombocytopenia (ITP). British Journal of Haematology, 151, 189-191.
66. Sarpatwari, A., Provan, D., Erqou, S., Sobnack, R., David Tai, F.W. & Newland, A.C. (2010b) Autologous 111 In-labelled platelet sequestration studies in patients with primary immune thrombocytopenia (ITP) prior to splenectomy: a report from the United Kingdom ITP Registry. British Journal of Haematology, 151, 477-487.
67. Semple, J.W., Italiano, J.E. Jr & Freedman, J. (2011) Platelets and the immune continuum. Nature Reviews Immunology, 11, 264-274.
68. Shirahata, A., Fujisawa, K., Ishii, E., Ohta, S., Sako, M., Takahashi, Y., Taki, M., Mimaya, J., Kubota, M., Miura, T., Kitazawa, J., Kajiwara, M. & Bessho, F.A. (2009) A nationwide survey of newly diagnosed childhood idiopathic thrombocytopenic purpura in Japan. Journal of Pediatric Hematology Oncology, 31, 27-32.
69. So, M.Y., Li, C.H., Lee, A.C. & Kwong, N.S. (2013) Intracranial haemorrhage among Chinese children with immune thrombocytopenia in a Hong Kong regional hospital. Hong Kong Medical Journal, 19, 129-134.
70. Tamminga, R., Berchtold, W., Bruin, M., Buchanan, G.R. & Kühne, T. (2009) Possible lower rate of chronic ITP after IVIG for acute childhood ITP an analysis from registry I of the Intercontinental Cooperative ITP Study Group (ICIS). British Journal of Haematology, 146, 180-184.
71. Thomsen, R.W., Schoonen, W.M., DrK, Farkas., Riis, A., Jacobsen, J., Fryzek, J.P. & Sørensen, H.T. (2009) Risk for hospital contract with infection in patients with splenectomy. Annals of Internal Medicine, 151, 546-555.
72. Thomsen, R.W., Schhnen, W.M., Farkas, D.K., Riis, A., Fryzek, J.P. & Sørensen, H.T. (2010) Risk of venous thromboembolism in splenectomized patients compared with the general population and appendectomized patients: a 10-year nationwide cohort study. Journal of Thrombosis and Haemostasis, 8, 1413-1416.
73. Treutiger, I., Rajantie, J., Zeller, B., Henter, J.I., Elinder, G. & Rosthøj, S.; NOPHO ITP Study Group. (2007) Does treatment of newly diagnosed idiopathic thrombocytopenic purpura reduce morbidity? Archives of Diseases in Childhood, 92, 704-707.
74. Young, M., Thomse, R.W., Schoonen, W.M., Farkas, D.K., Riis, A., Fryzek, J.P. & Sorensen, H.T. (2010) Mortality risk in splenectomised patients: a Danish population-based cohort study. European Journal of Internal Medicine, 21, 12-16.
75. Yri, O.E., Torfoss, D., Hungnes, O., Tierens, A., Waalen, K., Nordøy, T., Dudman, S., Kilander, A., Wader, K.F., Ostenstad, B., Ekanger, R., Meyer, P. & Kolstad, A. (2011) Rituximab blocks protective serologic response to influenza A (H1N1) vaccination in lymphoma patients during or within 6 months after treatment. Blood, 118, 6769-6771.
76. Zilber, R., Bortz, A.P., Yacobovich, J., Yaniv, I. & Tamary, H. (2012) Analysis of health-related quality of life in children with immune thrombocytopenia and their parents using the kids' ITP tools. Journal of Pediatric Hematology and Oncology, 34, 2-5.