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Hamostaseologie 2023; 43(02): 132-141
DOI: 10.1055/a-1767-0304
Original Article

Immune Thrombocytopenia: Characteristics of the Population and Treatment Methods—One-Center Experience

Weronika Lebowa
1   Department of Haematology, University Hospital, Jagiellonian University Medical College, Cracow, Poland
,
Joanna Zdziarska
1   Department of Haematology, University Hospital, Jagiellonian University Medical College, Cracow, Poland
,
Tomasz Sacha
1   Department of Haematology, University Hospital, Jagiellonian University Medical College, Cracow, Poland
2   Department of Haematology, Jagiellonian University Medical College, Cracow, Poland
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Abstract

Background Immune thrombocytopenia (ITP) is a disease with variable clinical presentation, requiring different treatment lines.

Aim The study aimed to characterize a group of ITP patients in terms of clinical picture and disease treatment, as well as to present the current standard of care of ITP in Poland, in the context of local and international guidelines.

Materials and Methods The study included adult patients diagnosed with ITP, treated at the Department of Haematology of the Jagiellonian University Hospital in Krakow from January 2006 to January 2021. Patient characteristics, clinical manifestation of ITP, and treatment methods were analyzed.

Results A total of 245 ITP patients were included. 57.1% of them were asymptomatic at diagnosis. Most common symptoms were thrombocytopenic purpura (68.2%), followed by epistaxis (34.7%) and gum bleeds (19.2%). Life-threatening bleedings were noted in three cases (1.2%). 23.2% of patients did not require treatment. Prednisone was the most commonly used first-line therapy (75.5% of patients). Treatment with eltrombopag and romiplostim was used in 40.4 and 8.5% of patients requiring second-line therapy, respectively. 14.3% of all patients ultimately underwent splenectomy, including 51.5% of those who needed second-line treatment. The initial response rate was 74.3%; however, post-splenectomy relapses occurred in 22.9% of patients.

Conclusions ITP is a disease of mild clinical course, often asymptomatic. Chronic disease often requires multiple treatment lines and balancing between bleeding risk and treatment toxicity, based on individual risk–benefit assessment. Local access restrictions to thrombopoietin receptor agonists determined the treatment strategy.

Zusammenfassung

Einleitung Immunthrombozytopenie (ITP) ist eine Krankheit mit variabler klinischer Ausprägung, die verschiedene Therapielinien benötigt.

Zielsetzung Ziel der Arbeit ist, eine Gruppe von Patienten mit ITP zu beschreiben, hinsichtlich der klinischen Manifestation und Therapie, als auch den aktuellen Behandlungsstandard von ITP in Polen vorzuführen, im Kontext von lokalen und internationalen Richtlinien.

Material und Methoden Die Analyze beinthaltet Klinik- und Therapiedaten von erwachsenen Patienten mit diagnostizierter ITP, die in der Klinik für Hämatologie der Jagiellonen-Universität in Krakau zwischen Januar 2006 und Januar 2021 betreut waren.

Ergebnisse 245 ITP-Patienten wurden identifiziert, von denen 57.1% waren asymptomatisch bei Diagnose. Die am häufigsten gemeldeten Symptome waren thrombozytopenische Purpura (68.2%), Nasenbluten (34.7%) und Zahnfleischbluten (19.2%). Lebensbedrohliche Blutung tritt auf in 3 Patienten (1.2%). In 23.2% der Patienten keine Therapie war notwendig. Prednison war die häufigste Erstlinientherapie (75.7% der Patienten). Eltrombopag und Romiplostim waren in 40.4% und 8.5% der Patienten verabreicht, die eine Zweitlinientherapie benötigten. Splenektomie wurde in 14.3% aller Patienten durchgeführt und in 51.5% deren, in denen Zweitlinientherapie nötig war. Die initiale Ansprechrate auf Splenektomie war 74.3%, jedoch 22.9% der Patienten erlitten ein Rückfall.

Schlussfolgerungen Das klinische Bild von ITP ist mild, oft symptomfrei. Chronische Krankheit benötigt dagegen oft viele Therapielinien. Balancieren zwischen Blutungsrisiko und Toxizität der Therapie ist nonwendig, anhand der individuellen Nutzen/Risiko-Abwägung. Lokale Einschränkungen der Verfügbarkeit der Thrombopoetin-Rezeptoragonisten determinierten die Therapiestrategie.

Keywords

immune thrombocytopenia - refractory ITP - splenectomy - thrombopoietin receptor agonists

Schlüsselwörter

Immunthrombozytopenie - therapieresistente ITP - Splenektomie - Thrombopoetin-Rezeptoragonisten


Publikationsverlauf

Eingereicht: 20. Juli 2021

Angenommen: 04. Februar 2022

Artikel online veröffentlicht:
02. Juni 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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