Contributions
Abstract: PB2349
Type: Publication Only
Background
ITP is a heterogeneous autoimmune disorder mediated by platelet (PLT) antibodies thought to accelerate PLT destruction while inhibiting also their production. ITP features in the general Greek population have not been properly investigated.
Aims
To access systematically, for the first time, the characteristics of adult patients (pts) receiving thrombopoietin receptor agonists (TPO-RAs), i.e. Romiplostim (R) and Eltrombopag (Ε), using data from the national database (ITP registry) operated under the auspices of the Hellenic Society of Hematology.
Methods
The greek ITP registry recruits pts (n=1167, to date) nationally through a network of 19 centers. In the present study we retrospectively analyzed data from adult ITP pts diagnosed from 1979 to 2017, who received R and E.
Results
The total number of evaluable adult pts was 69 (29 Μ; 40F) and the median age at diagnosis was 54 years (20-88). R was administered in 27 pts and E in 42 pts, with a median age of 59.8 years and 58.6 years, respectively. 94% of the pts started R from 2009 to 2013 and 95% started E from 2012 to 2016. The median time from ITP diagnosis to R and E administration was 12 months (0.5-360) and 8 months (0.4-265) respectively. The mean number of prior ITP therapies was 2.3 (1-5) in the R- and 2 (1-7) in the E-cohort (P=0.061). Similar proportions of pts in the R- and E-cohort, respectively, had received corticosteroids (26/27 & 4/42), intravenous immunoglobulin (20/27 & 24/42), rituximab (5/27 & 3/42), vinblastine (3/27 & 2/42), immunosuppressants (2/27 & 2/42), vincristine (1/27 & 1/42) and had undergone splenectomy (3/27 & 2/42). Anti-RhD immunoglobulin was administered in 1/27 pts in the R-cohort and Danazol in 1/42 pts in the E-cohort. The median PLT number at R or E initiation was 20.42x109/L and 25.03x109/L respectively, P=0.254. Similar PLT counts were observed between pts receiving R and E at 6 months (163.9x109/L & 151x109/L, respectively, P= 0.8937) and at 12 months (166.5x109/L & 157.4x109/L respectively, P=0.7236). Patients remained on R and E treatment for a median of 23.5 months (0.5-106) and 15.5 months (0.4-75), respectively. There was no difference in complete response (CR, ie PLT count above 100x109/L) to R and E (62% & 59%, respectively, P=0.192) or partial response, i.e. PLT count 30-100x109/L, (19% & 22%, respectively, P=0,7264). 14(52%) pts in the R-cohort discontinued R: 2 in CR stopped R maintaining a sustained remission after discontinuation, 6 had no response, 2 due to adverse effects (gastrointestinal disorders, headache) and 4 underwent splenectomy. After R discontinuation, 10 pts received E, 8 of whom responded. In 2 non-responders additional therapies included corticosteroids, vinblastine, intravenous IgG and Rituximab. 14 (33%) pts in the E-cohort discontinued E: 4 in CR stopped E obtaining a sustained remission after discontinuation, 5 had no response, 4 due to adverse effects (hepatotoxicity, pulmonary embolism, retinal artery thrombosis) & 1 underwent splenectomy. Following E discontinuation 4 pts received R, 1 of whom responded. Other treatments included intravenous immunoglobulin, danazol, splenectomy and corticosteroids.
Conclusion
Our real-life multicenter retrospective analysis on the use of TPO-RAs suggests that both R and E have acceptable toxicity profiles and are highly effective in adult ITP pts failing 1 or more lines of therapy. TPO-RA switch is a feasible strategy that can be beneficial, at least in some cases.
Session topic: 33. Platelets disorders
Keyword(s): adult, Immune thrombocytopenia (ITP)
Abstract: PB2349
Type: Publication Only
Background
ITP is a heterogeneous autoimmune disorder mediated by platelet (PLT) antibodies thought to accelerate PLT destruction while inhibiting also their production. ITP features in the general Greek population have not been properly investigated.
Aims
To access systematically, for the first time, the characteristics of adult patients (pts) receiving thrombopoietin receptor agonists (TPO-RAs), i.e. Romiplostim (R) and Eltrombopag (Ε), using data from the national database (ITP registry) operated under the auspices of the Hellenic Society of Hematology.
Methods
The greek ITP registry recruits pts (n=1167, to date) nationally through a network of 19 centers. In the present study we retrospectively analyzed data from adult ITP pts diagnosed from 1979 to 2017, who received R and E.
Results
The total number of evaluable adult pts was 69 (29 Μ; 40F) and the median age at diagnosis was 54 years (20-88). R was administered in 27 pts and E in 42 pts, with a median age of 59.8 years and 58.6 years, respectively. 94% of the pts started R from 2009 to 2013 and 95% started E from 2012 to 2016. The median time from ITP diagnosis to R and E administration was 12 months (0.5-360) and 8 months (0.4-265) respectively. The mean number of prior ITP therapies was 2.3 (1-5) in the R- and 2 (1-7) in the E-cohort (P=0.061). Similar proportions of pts in the R- and E-cohort, respectively, had received corticosteroids (26/27 & 4/42), intravenous immunoglobulin (20/27 & 24/42), rituximab (5/27 & 3/42), vinblastine (3/27 & 2/42), immunosuppressants (2/27 & 2/42), vincristine (1/27 & 1/42) and had undergone splenectomy (3/27 & 2/42). Anti-RhD immunoglobulin was administered in 1/27 pts in the R-cohort and Danazol in 1/42 pts in the E-cohort. The median PLT number at R or E initiation was 20.42x109/L and 25.03x109/L respectively, P=0.254. Similar PLT counts were observed between pts receiving R and E at 6 months (163.9x109/L & 151x109/L, respectively, P= 0.8937) and at 12 months (166.5x109/L & 157.4x109/L respectively, P=0.7236). Patients remained on R and E treatment for a median of 23.5 months (0.5-106) and 15.5 months (0.4-75), respectively. There was no difference in complete response (CR, ie PLT count above 100x109/L) to R and E (62% & 59%, respectively, P=0.192) or partial response, i.e. PLT count 30-100x109/L, (19% & 22%, respectively, P=0,7264). 14(52%) pts in the R-cohort discontinued R: 2 in CR stopped R maintaining a sustained remission after discontinuation, 6 had no response, 2 due to adverse effects (gastrointestinal disorders, headache) and 4 underwent splenectomy. After R discontinuation, 10 pts received E, 8 of whom responded. In 2 non-responders additional therapies included corticosteroids, vinblastine, intravenous IgG and Rituximab. 14 (33%) pts in the E-cohort discontinued E: 4 in CR stopped E obtaining a sustained remission after discontinuation, 5 had no response, 4 due to adverse effects (hepatotoxicity, pulmonary embolism, retinal artery thrombosis) & 1 underwent splenectomy. Following E discontinuation 4 pts received R, 1 of whom responded. Other treatments included intravenous immunoglobulin, danazol, splenectomy and corticosteroids.
Conclusion
Our real-life multicenter retrospective analysis on the use of TPO-RAs suggests that both R and E have acceptable toxicity profiles and are highly effective in adult ITP pts failing 1 or more lines of therapy. TPO-RA switch is a feasible strategy that can be beneficial, at least in some cases.
Session topic: 33. Platelets disorders
Keyword(s): adult, Immune thrombocytopenia (ITP)