PREVALENCE AND RISK FACTORS FOR THROMBOSIS IN ADULT ITP PATIENTS TREATED WITH TPO-RA
Author(s): ,
Maria L Lozano
Affiliations:
Hematology and Medical Oncology Deparment,Hospital General Universitario Morales Meseguer. University of Murcia. IMIB-Arrixaca. CIBERER,Murcia,Spain
,
María Eva Mingot
Affiliations:
Complejo Hospitalario Regional de Málaga,Málaga,Spain
,
María Perera
Affiliations:
Complejo Hospitalario Universitario de Gran Canaria Dr. Negrín,Las Palmas de Gran Canaria,Spain
,
Isidro Jarque
Affiliations:
Hospital Universitari i Politècnic la Fe,Valencia,Spain
,
Rosa Campos
Affiliations:
Hospital de Especialidades de Jerez de la Frontera,Jerez de la Frontera,Spain
,
Tomás José González
Affiliations:
Hospital Universitario de Burgos,Burgos,Spain
,
Gonzalo Carreño
Affiliations:
Hospital Universitario 12 de Octubre,Madrid,Spain
,
Nuria Bermejo
Affiliations:
Hospital San Pedro de Alcántara,Cáceres,Spain
,
María Fernanda López
Affiliations:
Hospital Universitario a Coruña,A Coruña,Spain
,
Aurora de Andrés
Affiliations:
Complexo Hospitalario Universitario de Santiago,Santiago de Compostela,Spain
,
David Valcárcel
Affiliations:
Hospital Universitari Vall d'Hebron,Barcelona,Spain
,
Felipe Casado
Affiliations:
Hospital Virgen de la Salud,Toledo,Spain
,
María Teresa Álvarez
Affiliations:
Hospital Universitario la Paz,Madrid,Spain
,
María Isabel Orts
Affiliations:
Hospital de Sagunto,Sagunto,Spain
,
Silvana Novelli
Affiliations:
Hospital de la Santa Creu i Sant Pau,Barcelona,Spain
,
José Ramón González
Affiliations:
Hospital Universitario de Salamanca,Salamanca,Spain
,
Estefanía Bolaños
Affiliations:
Hospital Clínico San Carlos,Madrid,Spain
,
Elsa López Ansoar
Affiliations:
Hospital Álvaro Cunqueiro,Lugo,Spain
,
Elisa Orna
Affiliations:
Hospital Universitari Germans Trias i Pujol,Barcelona,Spain
Vicente Vicente
Affiliations:
Hospital Morales Meseguer,Murcia,Spain
EHA Library. Lozano M. Jun 15, 2019; 267197; PS1580
Dr. María Lozano
Dr. María Lozano
Contributions
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Abstract

Abstract: PS1580

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Background
Thrombopoietin-receptor-agonists (TPO-RA) are effective treatments of immune thrombocytopenia (ITP). Previous long-term TPO-RA clinical trials have shown that thrombotic events occurred in 6% of TPO-RA-treated ITP patients, with thrombotic events appearing to be more frequent in patients of older age and having at least 1 general risk factor for thrombosis.

Aims
To evaluate the prevalence of venous and arterial thrombosis in patients with primary ITP during treatment with TPO-RA.

Methods
Multicenter retrospective study that included 121 adult primary ITP patients from 19 secondary and tertiary Spanish hospitals who had initiated treatment with Romiplostim (ROM) or Eltrombopag (ELT) as long-term therapy between January 2012 and December 2014. Information on patient characteristics was collected from medical records to assess and compare risk factors of ITP patients with and without vascular events (VE).

Results
A total of 121 patients (median age 63 years, range 19-96 years; 68% chronic phase), initiated TPO-RA (ROM 54; EPG 67). During a 329.3 patient-year time under treatment (exposure to ROM and ELT of 161.03 and 168.27 patient-year, respectively) 15 patients experienced 17 vascular episodes (9 arterial, 8 venous). One patient presented antiphospholipid antibodies, five had been diagnosed with neoplasia, one with vascular peripheral disease, two with hypothyroidism –one of whom also had renal disease-. Seven events occurred with ROM, and 10 with ELT. The annualized risk was 4.2 and 5.9  VE/100 patient-years in ROM and ELT treated patients, respectively (median 5.2). Most VE occurred in the first year of TPO-RA therapy (median 276 days; 5-1183), with a trend toward earlier events under ROM than ELT (127 days vs 360 days, respectively; p=0.070). In the case of ischemic events the median time to arterial events was  165 vs. 606 days in ROM and ELT treated patients; P= 0.029. There were no significant differences in the 15 patients vs. the 106 patients that did not suffer from vascular events in terms of gender, age, diabetes, hypertension, previous vascular events, nor time on prednisone as 1st line therapy. In patients experiencing VE on TPO-RA, a significant association with previous splenectomy (53.3% vs. 25.5%, P=0.026), and chronic phase of the disease (93.3% vs. 64.1%, P=0.024) compared with those not having such characteristic was detected. Surprisingly previous malignancy significantly associated with VE under TPO-RA treatment (33% vs. 2.8%, P=0.000009). All patients were reported to have sustained complete remission of previous neoplasias (1 colon carcinoma; 1 Burkitt lymphoma; 1 bladder cancer; 1 breast cancer; 1 patient with history of thyroid, breast and ovarian tumors) and were not receiving antineoplastic therapies. In multivariate analysis with logistic regression only previous malignancy predicted significantly higher odds of VE (Table 1).

Conclusion
In this study, we describe an annualized risk of 5.2 vascular events/100 patient-years in TPO-RA treated patients. Venous and arterial thromboembolism are not frequent complications in ITP patients under TPO-RA, except in particular settings, such as in splenectomized and chronic patients. Our data revealed a novel association of history of previous neoplasia with thrombotic events in patients with TPO-RA. These results suggest that a history of prior cancer should be systematically screened before TPO-RA initiation, and if so, alternative therapy should be considered; however, due to the limited sample size, further research is warranted.

Session topic: 34. Thrombosis and vascular biology - Biology & Translational Research

Keyword(s): Cancer, ITP, Thrombosis

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