Current and evolving treatment strategies in adult immune thrombocytopenia

Abstract

Immune thrombocytopenia (ITP) is an acquired autoimmune phenomenon resulting in low platelet count and increased bleeding risk. Goals of upfront management include prompt control of severe bleeding-which is rare-as well as induction and maintenance of a hemostatic platelet count. Thus, optimal management of ITP patients is often challenging and requires a highly individualized approach. Many patients may not suffer significant bleeding despite severe thrombocytopenia and the risk of toxicity associated with treatment may outweigh its benefit. Most patients treated with standard first-line regimen of glucocorticoids achieve an initial response. However, the rate of long-term remission remains low and multiple lines of therapy are often required. Current investigations aim at defining the subgroup of patients at risk of relapse and providing intensified risk-balanced induction regimens to improve long-term disease control. This short review summarizes current and emerging treatment strategies in adult ITP.

Keywords: Dexamethasone; Eltrombopag; Rituximab; Romiplostim; Splenectomy.

Fig. 1

Treatment algorithm in adult immune thrombocytopenia. ITP immune thrombocytopenia, IvIg intravenous immunglobuline, TRA thrombopoietin receptor agonist, MMF mycophenolate mofetil, CSA cyclosporine A, AZA azathioprine, HRQoL health-releated quality of life, p.o. per os, s.c. subcutaneously, d day, * alternatively prednisolone 1‑2 mg/kg per day over several weeks with a 4‑6 week taper