THROMBOPOIETIN-RECEPTOR AGONISTS (TPO-RAS) IN IMMUNE THROMBOCYTOPENIA (ITP): EXPERIENCE IN OUR CENTER
(Abstract release date: 05/19/16)
EHA Library. Javier González K. 06/09/16; 134979; PB2079
Dr. Karla Javier González
Contributions
Contributions
Abstract
Abstract: PB2079
Type: Publication Only
Background
Thrombopoietin-receptor agonists (TPO-RAs), Romiplostim (ROM) and Eltrombopag (ELT) constitute an effective therapeutic option for patients with immune thrombocytopenia (ITP). However, several questions remain unclear concerning their use.
Aims
Our aim is to describe our experience with the use of TPO-RAs in ITP with particular reference to sequential treatment with both drugs, their use prior to invasive procedures and the prognostic factors for response.
Methods
We reviewed all patients with ITP who received treatment with TPO-RAs at standard doses in our department. The following variables were evaluated: age, gender, platelet count, previous treatments (including splenectomy), time of follow- up from diagnosis and response to TPO-RAs. Response was defined by the ITP International Working Group response criteria. Comparisons between categorical variables were made with χ 2 or Fisher exact test and Mann-Whitney U test was used for quantitative variables. Logistic regression was used to identify factors associated with response.
Results
Between October 2009 and December 2015, 49 patients were treated with TPO-RAs, 17 men and 32 women, with a median age of 67 years. 36 patients received treatment with ROM (32 as first line and 4 as second line TPO-RAs) and 34 with ELT (17 1st line, 17 2nd line), with a median platelet count of 19.000 (range 2000-78000) before starting treatment. The overall response with ROM was 83% (30/36) and 74% (25/34) for ELT.10 patients were treated with TPO-RAs previous to invasive procedures, 6 with one dose of ROM and 4 with ELT for a month. 6 patients achieved response, 4 with ROM and 2 with ELT.21 patients with ITP were treated with both ROM and ELT sequentially. Response was observed in 13 of 17 patients switched from ROM to ELT, including 2 of 3 non-responders to ROM. Three of 4 patients switched from ELT to ROM responded to treatment. Response rate for patients switched because of relapse after transient response was observed in 5 of 9 patients; in contrast, 8 patients switching because of poor tolerance or personal preference achieved response.There was no statistical difference between responders and refractory patients in terms of age, gender, platelet count before therapy, splenectomy or number of previous treatments ( table 1). Patients who initially responded to corticoids had a higher response rate to TPO-RAs. In logistic regression only initial response to corticoids showed prognostic impact with a hazard ratio of 10,5 (p=0,005).
Conclusion
TPO-RAs are an effective salvage therapy for refractory ITP. Switching from one TPO-RAs to the other is an effective option. TPO-RAs could be a useful treatment option when aiming a rapid platelet count increase. Initial response to corticosteroids is the only predictive factor of response in our study.
Session topic: E-poster
Keyword(s): Immune thrombocytopenia (ITP)
Type: Publication Only
Background
Thrombopoietin-receptor agonists (TPO-RAs), Romiplostim (ROM) and Eltrombopag (ELT) constitute an effective therapeutic option for patients with immune thrombocytopenia (ITP). However, several questions remain unclear concerning their use.
Aims
Our aim is to describe our experience with the use of TPO-RAs in ITP with particular reference to sequential treatment with both drugs, their use prior to invasive procedures and the prognostic factors for response.
Methods
We reviewed all patients with ITP who received treatment with TPO-RAs at standard doses in our department. The following variables were evaluated: age, gender, platelet count, previous treatments (including splenectomy), time of follow- up from diagnosis and response to TPO-RAs. Response was defined by the ITP International Working Group response criteria. Comparisons between categorical variables were made with χ 2 or Fisher exact test and Mann-Whitney U test was used for quantitative variables. Logistic regression was used to identify factors associated with response.
Results
Between October 2009 and December 2015, 49 patients were treated with TPO-RAs, 17 men and 32 women, with a median age of 67 years. 36 patients received treatment with ROM (32 as first line and 4 as second line TPO-RAs) and 34 with ELT (17 1st line, 17 2nd line), with a median platelet count of 19.000 (range 2000-78000) before starting treatment. The overall response with ROM was 83% (30/36) and 74% (25/34) for ELT.10 patients were treated with TPO-RAs previous to invasive procedures, 6 with one dose of ROM and 4 with ELT for a month. 6 patients achieved response, 4 with ROM and 2 with ELT.21 patients with ITP were treated with both ROM and ELT sequentially. Response was observed in 13 of 17 patients switched from ROM to ELT, including 2 of 3 non-responders to ROM. Three of 4 patients switched from ELT to ROM responded to treatment. Response rate for patients switched because of relapse after transient response was observed in 5 of 9 patients; in contrast, 8 patients switching because of poor tolerance or personal preference achieved response.There was no statistical difference between responders and refractory patients in terms of age, gender, platelet count before therapy, splenectomy or number of previous treatments ( table 1). Patients who initially responded to corticoids had a higher response rate to TPO-RAs. In logistic regression only initial response to corticoids showed prognostic impact with a hazard ratio of 10,5 (p=0,005).
| Response | No Response | p | |||
| Gender | Male | 14 | 3 | p=1 | |
| Female | 26 | 6 | |||
| Age (median) years | 66.5y (26-88y) | 68y (34-76y) | p=0,638 | ||
| Initial platelet count | 19,500 (2000-74.000) | 13,000 (4-78,000) | p=0,998 | ||
| Splenectomy | Yes | 12 (80%) | 3 (20%) | p=1 | |
| No | 28 (82%) | 6 (18%) | |||
| Nº previous treatments | (1-2) | 32 (82%) | 7 (18%) | p=0,848 | |
| (3-4) | 8 (80%) | 2 (20%) | |||
| Initial response to corticosteroids | Yes | 30 (75%) | 10 (25%) | p=0,005 | |
Conclusion
TPO-RAs are an effective salvage therapy for refractory ITP. Switching from one TPO-RAs to the other is an effective option. TPO-RAs could be a useful treatment option when aiming a rapid platelet count increase. Initial response to corticosteroids is the only predictive factor of response in our study.
Session topic: E-poster
Keyword(s): Immune thrombocytopenia (ITP)
Abstract: PB2079
Type: Publication Only
Background
Thrombopoietin-receptor agonists (TPO-RAs), Romiplostim (ROM) and Eltrombopag (ELT) constitute an effective therapeutic option for patients with immune thrombocytopenia (ITP). However, several questions remain unclear concerning their use.
Aims
Our aim is to describe our experience with the use of TPO-RAs in ITP with particular reference to sequential treatment with both drugs, their use prior to invasive procedures and the prognostic factors for response.
Methods
We reviewed all patients with ITP who received treatment with TPO-RAs at standard doses in our department. The following variables were evaluated: age, gender, platelet count, previous treatments (including splenectomy), time of follow- up from diagnosis and response to TPO-RAs. Response was defined by the ITP International Working Group response criteria. Comparisons between categorical variables were made with χ 2 or Fisher exact test and Mann-Whitney U test was used for quantitative variables. Logistic regression was used to identify factors associated with response.
Results
Between October 2009 and December 2015, 49 patients were treated with TPO-RAs, 17 men and 32 women, with a median age of 67 years. 36 patients received treatment with ROM (32 as first line and 4 as second line TPO-RAs) and 34 with ELT (17 1st line, 17 2nd line), with a median platelet count of 19.000 (range 2000-78000) before starting treatment. The overall response with ROM was 83% (30/36) and 74% (25/34) for ELT.10 patients were treated with TPO-RAs previous to invasive procedures, 6 with one dose of ROM and 4 with ELT for a month. 6 patients achieved response, 4 with ROM and 2 with ELT.21 patients with ITP were treated with both ROM and ELT sequentially. Response was observed in 13 of 17 patients switched from ROM to ELT, including 2 of 3 non-responders to ROM. Three of 4 patients switched from ELT to ROM responded to treatment. Response rate for patients switched because of relapse after transient response was observed in 5 of 9 patients; in contrast, 8 patients switching because of poor tolerance or personal preference achieved response.There was no statistical difference between responders and refractory patients in terms of age, gender, platelet count before therapy, splenectomy or number of previous treatments ( table 1). Patients who initially responded to corticoids had a higher response rate to TPO-RAs. In logistic regression only initial response to corticoids showed prognostic impact with a hazard ratio of 10,5 (p=0,005).
Conclusion
TPO-RAs are an effective salvage therapy for refractory ITP. Switching from one TPO-RAs to the other is an effective option. TPO-RAs could be a useful treatment option when aiming a rapid platelet count increase. Initial response to corticosteroids is the only predictive factor of response in our study.
Session topic: E-poster
Keyword(s): Immune thrombocytopenia (ITP)
Type: Publication Only
Background
Thrombopoietin-receptor agonists (TPO-RAs), Romiplostim (ROM) and Eltrombopag (ELT) constitute an effective therapeutic option for patients with immune thrombocytopenia (ITP). However, several questions remain unclear concerning their use.
Aims
Our aim is to describe our experience with the use of TPO-RAs in ITP with particular reference to sequential treatment with both drugs, their use prior to invasive procedures and the prognostic factors for response.
Methods
We reviewed all patients with ITP who received treatment with TPO-RAs at standard doses in our department. The following variables were evaluated: age, gender, platelet count, previous treatments (including splenectomy), time of follow- up from diagnosis and response to TPO-RAs. Response was defined by the ITP International Working Group response criteria. Comparisons between categorical variables were made with χ 2 or Fisher exact test and Mann-Whitney U test was used for quantitative variables. Logistic regression was used to identify factors associated with response.
Results
Between October 2009 and December 2015, 49 patients were treated with TPO-RAs, 17 men and 32 women, with a median age of 67 years. 36 patients received treatment with ROM (32 as first line and 4 as second line TPO-RAs) and 34 with ELT (17 1st line, 17 2nd line), with a median platelet count of 19.000 (range 2000-78000) before starting treatment. The overall response with ROM was 83% (30/36) and 74% (25/34) for ELT.10 patients were treated with TPO-RAs previous to invasive procedures, 6 with one dose of ROM and 4 with ELT for a month. 6 patients achieved response, 4 with ROM and 2 with ELT.21 patients with ITP were treated with both ROM and ELT sequentially. Response was observed in 13 of 17 patients switched from ROM to ELT, including 2 of 3 non-responders to ROM. Three of 4 patients switched from ELT to ROM responded to treatment. Response rate for patients switched because of relapse after transient response was observed in 5 of 9 patients; in contrast, 8 patients switching because of poor tolerance or personal preference achieved response.There was no statistical difference between responders and refractory patients in terms of age, gender, platelet count before therapy, splenectomy or number of previous treatments ( table 1). Patients who initially responded to corticoids had a higher response rate to TPO-RAs. In logistic regression only initial response to corticoids showed prognostic impact with a hazard ratio of 10,5 (p=0,005).
| Response | No Response | p | |||
| Gender | Male | 14 | 3 | p=1 | |
| Female | 26 | 6 | |||
| Age (median) years | 66.5y (26-88y) | 68y (34-76y) | p=0,638 | ||
| Initial platelet count | 19,500 (2000-74.000) | 13,000 (4-78,000) | p=0,998 | ||
| Splenectomy | Yes | 12 (80%) | 3 (20%) | p=1 | |
| No | 28 (82%) | 6 (18%) | |||
| Nº previous treatments | (1-2) | 32 (82%) | 7 (18%) | p=0,848 | |
| (3-4) | 8 (80%) | 2 (20%) | |||
| Initial response to corticosteroids | Yes | 30 (75%) | 10 (25%) | p=0,005 | |
Conclusion
TPO-RAs are an effective salvage therapy for refractory ITP. Switching from one TPO-RAs to the other is an effective option. TPO-RAs could be a useful treatment option when aiming a rapid platelet count increase. Initial response to corticosteroids is the only predictive factor of response in our study.
Session topic: E-poster
Keyword(s): Immune thrombocytopenia (ITP)
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