Platelet and peripheral white blood cell counts at diagnosis predict the response of adult immune thrombocytopenia to recombinant human interleukin-11: A retrospective, single-center, case-control study

Abstract

This study evaluated the effectiveness of recombinant human interleukin-11 (rhIL-11) in the treatment of immune thrombocytopenia (ITP) and determined whether clinical and laboratory findings predicted the treatment response.This retrospective, single-center, case-control study included 103 adult patients with ITP treated between July 2010 and April 2014 at Jiangxi Province People's Hospital. About 49 patients in the pred+IL group received prednisone (conventional dose) combined with an rhIL-11 regimen, and 54 patients in the pred alone group received prednisone (conventional dose) alone. Demographic data, initial and follow-up platelet counts, proportions of patients achieving platelet counts ≥30 × 10/L (response) and ≥100 × 10/L (complete response) at different time points, and adverse reactions were compared between groups.Complete response rates were similar between groups overall but higher in the pred+IL group than in the pred alone group for newly diagnosed patients and those with severe ITP (P < .05). Proportions of patients achieving response or complete response at different time points were similar between groups overall but higher in the pred+IL group than in the pred alone group for newly diagnosed patients and those with severe ITP (P < .05). Posttreatment platelet count correlated negatively with platelet count at diagnosis and white blood cell (WBC) count at diagnosis in patients with newly diagnosed ITP (r = -0.337, P = .073 and r = -0.367, P = .050, respectively) or ITP with bleeding-related episodes (r = -0.357, P = .020 and r = -0.434, P = .004, respectively). No immediate or postinfusion severe adverse reactions were observed.rhIL-11 increased CR and improved hemostasis in patients with newly diagnosed or severe ITP. Platelet and WBC counts at diagnosis can predict the response to rhIL-11.

Figure 1

Comparison of treatment response rates after 28 days of therapy between patients with immune thrombocytopenia (ITP) treated with prednisone alone and those treated with prednisone combined with recombinant human interleukin-11 (rhIL-11). (A) Treatment response rates in all patients. (B) Treatment response rates in patients with severe ITP. (C) Treatment response rates in patients with newly diagnosed ITP. (D) Treatment response rates in patients treated with prednisone alone, comparing severe ITP vs non-severe ITP. (E) Treatment response rates in patients treated with prednisone combined with rhIL-11, comparing severe ITP vs non-severe ITP. ∗P < .05. CR = complete response, NR = no response, R = response.

Figure 2

Comparison of treatment responses at 3, 7, 14, and 28 days posttreatment in patients with immune thrombocytopenia (ITP). (A, C, E, G) Proportion of patients in each group achieving a platelet count ≥30 × 10⁹/L. (B, D, F, H) Proportion of patients in each group achieving a platelet count ≥100 × 10⁹/L. (A, B) All patients with ITP. (C, D) Patients with newly diagnosed ITP. (E, F) Patients with ITP and bleeding-related episodes. (G, H) Patients with severe ITP. ∗P < .05.

Figure 3

Correlations between peripheral blood count before treatment and platelet count posttreatment in patients with immune thrombocytopenia (ITP). (A, D, G) Correlation between posttreatment platelet count and white blood cell count at diagnosis. (B, E, H) Correlation between posttreatment platelet count and hemoglobin level at diagnosis. (C, F, I) Correlation between posttreatment platelet count and platelet count at diagnosis in all patients with ITP. (A, E, G) Correlation between posttreatment platelet count and platelet count at diagnosis in patients with newly diagnosed ITP. (B, F, I) Correlation between posttreatment platelet count and platelet count at diagnosis in patients with ITP and bleeding-related episodes. r = correlation coefficient.