THROMBOPOIETIN MIMETICS AS ?A BRIDGE TO RECOVERY?. SINGLE CENTER EXPERIENCE IN FOUR PATIENTS WITH CHRONIC PRIMARY IMMUNE THROMBOCYTOPENIA.
(Abstract release date: 05/19/16)
EHA Library. Consoli U. 06/09/16; 134957; PB2057
Dr. Ugo Consoli
Contributions
Contributions
Abstract
Abstract: PB2057
Type: Publication Only
Background
The thrombopoietin (TPO) mimetics are approved for the treatment of chronic primary immune thrombocytopenia (ITP) and have the potential for use in several additional clinical settings. Treatment is usually indicated in patients with platelet counts<30 x 109/L and those with counts between 30 and 50 x 109/L with bleeding or at risk of bleeding (e.g planned surgery, dental extraction, parturition, active peptic ulcer). Although most ITP patients require initial or second line treatment, sometimes platelet levels or hemorrhagic manifestations are not clinically relevant and observation may represent an acceptable clinical strategy. Unfortunately, clinical management of chronic ITP may change over time because of the onset of new clinical condition that may require a temporary higher platelets number for a safe clinical management. Surgery, cancer chemotherapy, dangerous activities may temporarily change the therapeutic strategy of patients with chronic ITP. In these patients there is a significant probability of obtaining some improvement or remission but “on demand treatment” with short courses of therapy (often with corticosteroids, IVIg or TPO mimetics) although warranted to manage bleeding or high-risk of bleeding, are poorly investigated and not sufficiently addressed in the current guidelines.
Aims
In particular some patients with a otherwise 'safe' platelet levels may require a temporary treatment to overcome the onset of new clinical conditions. Here, we report on four patients with refractory ITP who received TPO-mimetics as a bridge to recovery from surgical procedures or chemotherapy treatment for diagnosis of cancer.
Methods
Four patients with isolated ITP were given TPO mimetics to increase the platelet count prior to initiation their medical o surgical treatment. We reviewed their baseline clinical characteristics, and clinical course.
Results
We found that a short course of Romiplostim or Eltrombopag may increase the platelet counts enough to enable surgery or to complete chemotherapy. All 4 patients achieved sustained remissions requiring no further treatment. No rebound thrombocytopenia was observed after stopping Romiplostim and none of the patients had bleeding or thrombotic complications.
Conclusion
Our clinical experience shows that TPO mimetics treatment, in certain patients with milder chronic ITP, may be chosen as intermittent treatment to temporarily raise platelet counts to overcome upcoming surgery, chemotherapy treatment or other clinical conditions requiring a 'safer' platelet level.
Session topic: E-poster
Keyword(s): ITP, TPO
Type: Publication Only
Background
The thrombopoietin (TPO) mimetics are approved for the treatment of chronic primary immune thrombocytopenia (ITP) and have the potential for use in several additional clinical settings. Treatment is usually indicated in patients with platelet counts<30 x 109/L and those with counts between 30 and 50 x 109/L with bleeding or at risk of bleeding (e.g planned surgery, dental extraction, parturition, active peptic ulcer). Although most ITP patients require initial or second line treatment, sometimes platelet levels or hemorrhagic manifestations are not clinically relevant and observation may represent an acceptable clinical strategy. Unfortunately, clinical management of chronic ITP may change over time because of the onset of new clinical condition that may require a temporary higher platelets number for a safe clinical management. Surgery, cancer chemotherapy, dangerous activities may temporarily change the therapeutic strategy of patients with chronic ITP. In these patients there is a significant probability of obtaining some improvement or remission but “on demand treatment” with short courses of therapy (often with corticosteroids, IVIg or TPO mimetics) although warranted to manage bleeding or high-risk of bleeding, are poorly investigated and not sufficiently addressed in the current guidelines.
Aims
In particular some patients with a otherwise 'safe' platelet levels may require a temporary treatment to overcome the onset of new clinical conditions. Here, we report on four patients with refractory ITP who received TPO-mimetics as a bridge to recovery from surgical procedures or chemotherapy treatment for diagnosis of cancer.
Methods
Four patients with isolated ITP were given TPO mimetics to increase the platelet count prior to initiation their medical o surgical treatment. We reviewed their baseline clinical characteristics, and clinical course.
Results
We found that a short course of Romiplostim or Eltrombopag may increase the platelet counts enough to enable surgery or to complete chemotherapy. All 4 patients achieved sustained remissions requiring no further treatment. No rebound thrombocytopenia was observed after stopping Romiplostim and none of the patients had bleeding or thrombotic complications.
Conclusion
Our clinical experience shows that TPO mimetics treatment, in certain patients with milder chronic ITP, may be chosen as intermittent treatment to temporarily raise platelet counts to overcome upcoming surgery, chemotherapy treatment or other clinical conditions requiring a 'safer' platelet level.
Session topic: E-poster
Keyword(s): ITP, TPO
Abstract: PB2057
Type: Publication Only
Background
The thrombopoietin (TPO) mimetics are approved for the treatment of chronic primary immune thrombocytopenia (ITP) and have the potential for use in several additional clinical settings. Treatment is usually indicated in patients with platelet counts<30 x 109/L and those with counts between 30 and 50 x 109/L with bleeding or at risk of bleeding (e.g planned surgery, dental extraction, parturition, active peptic ulcer). Although most ITP patients require initial or second line treatment, sometimes platelet levels or hemorrhagic manifestations are not clinically relevant and observation may represent an acceptable clinical strategy. Unfortunately, clinical management of chronic ITP may change over time because of the onset of new clinical condition that may require a temporary higher platelets number for a safe clinical management. Surgery, cancer chemotherapy, dangerous activities may temporarily change the therapeutic strategy of patients with chronic ITP. In these patients there is a significant probability of obtaining some improvement or remission but “on demand treatment” with short courses of therapy (often with corticosteroids, IVIg or TPO mimetics) although warranted to manage bleeding or high-risk of bleeding, are poorly investigated and not sufficiently addressed in the current guidelines.
Aims
In particular some patients with a otherwise 'safe' platelet levels may require a temporary treatment to overcome the onset of new clinical conditions. Here, we report on four patients with refractory ITP who received TPO-mimetics as a bridge to recovery from surgical procedures or chemotherapy treatment for diagnosis of cancer.
Methods
Four patients with isolated ITP were given TPO mimetics to increase the platelet count prior to initiation their medical o surgical treatment. We reviewed their baseline clinical characteristics, and clinical course.
Results
We found that a short course of Romiplostim or Eltrombopag may increase the platelet counts enough to enable surgery or to complete chemotherapy. All 4 patients achieved sustained remissions requiring no further treatment. No rebound thrombocytopenia was observed after stopping Romiplostim and none of the patients had bleeding or thrombotic complications.
Conclusion
Our clinical experience shows that TPO mimetics treatment, in certain patients with milder chronic ITP, may be chosen as intermittent treatment to temporarily raise platelet counts to overcome upcoming surgery, chemotherapy treatment or other clinical conditions requiring a 'safer' platelet level.
Session topic: E-poster
Keyword(s): ITP, TPO
Type: Publication Only
Background
The thrombopoietin (TPO) mimetics are approved for the treatment of chronic primary immune thrombocytopenia (ITP) and have the potential for use in several additional clinical settings. Treatment is usually indicated in patients with platelet counts<30 x 109/L and those with counts between 30 and 50 x 109/L with bleeding or at risk of bleeding (e.g planned surgery, dental extraction, parturition, active peptic ulcer). Although most ITP patients require initial or second line treatment, sometimes platelet levels or hemorrhagic manifestations are not clinically relevant and observation may represent an acceptable clinical strategy. Unfortunately, clinical management of chronic ITP may change over time because of the onset of new clinical condition that may require a temporary higher platelets number for a safe clinical management. Surgery, cancer chemotherapy, dangerous activities may temporarily change the therapeutic strategy of patients with chronic ITP. In these patients there is a significant probability of obtaining some improvement or remission but “on demand treatment” with short courses of therapy (often with corticosteroids, IVIg or TPO mimetics) although warranted to manage bleeding or high-risk of bleeding, are poorly investigated and not sufficiently addressed in the current guidelines.
Aims
In particular some patients with a otherwise 'safe' platelet levels may require a temporary treatment to overcome the onset of new clinical conditions. Here, we report on four patients with refractory ITP who received TPO-mimetics as a bridge to recovery from surgical procedures or chemotherapy treatment for diagnosis of cancer.
Methods
Four patients with isolated ITP were given TPO mimetics to increase the platelet count prior to initiation their medical o surgical treatment. We reviewed their baseline clinical characteristics, and clinical course.
Results
We found that a short course of Romiplostim or Eltrombopag may increase the platelet counts enough to enable surgery or to complete chemotherapy. All 4 patients achieved sustained remissions requiring no further treatment. No rebound thrombocytopenia was observed after stopping Romiplostim and none of the patients had bleeding or thrombotic complications.
Conclusion
Our clinical experience shows that TPO mimetics treatment, in certain patients with milder chronic ITP, may be chosen as intermittent treatment to temporarily raise platelet counts to overcome upcoming surgery, chemotherapy treatment or other clinical conditions requiring a 'safer' platelet level.
Session topic: E-poster
Keyword(s): ITP, TPO
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