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Clinical Phenotype and Response to Different Lines of Therapy in Elderly with Immune Thrombocytopenia: A Retrospective Study

PURPOSE: Insufficient knowledge of primary immune thrombocytopenia purpura (ITP) in the elderly, together with a lack of clinical trial data, has resulted in wide variation in treatments. Here, we present a study focused on clinical characteristics of ITP in older subjects at diagnosis integrated wi...

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Autores principales: Mancuso, Salvatrice, Carlisi, Melania, Serra, Nicola, Napolitano, Mariasanta, Raso, Simona, Consoli, Ugo, Palazzolo, Roberto, Lanza Cariccio, Maria Rosa, Siragusa, Sergio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415458/
https://www.ncbi.nlm.nih.gov/pubmed/32801981
http://dx.doi.org/10.2147/JBM.S256620
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author Mancuso, Salvatrice
Carlisi, Melania
Serra, Nicola
Napolitano, Mariasanta
Raso, Simona
Consoli, Ugo
Palazzolo, Roberto
Lanza Cariccio, Maria Rosa
Siragusa, Sergio
author_facet Mancuso, Salvatrice
Carlisi, Melania
Serra, Nicola
Napolitano, Mariasanta
Raso, Simona
Consoli, Ugo
Palazzolo, Roberto
Lanza Cariccio, Maria Rosa
Siragusa, Sergio
author_sort Mancuso, Salvatrice
collection PubMed
description PURPOSE: Insufficient knowledge of primary immune thrombocytopenia purpura (ITP) in the elderly, together with a lack of clinical trial data, has resulted in wide variation in treatments. Here, we present a study focused on clinical characteristics of ITP in older subjects at diagnosis integrated with the subsequent course of the disease and treatment history. METHODS: In a retrospective monoinstitutional study, we evaluated >65-year-old patients with primary ITP. Clinical characteristics at the time of diagnosis were described and analyzed. We aimed to delineate whether subsequent lines of therapy influenced the number of relapses. In addition to initial regimens, we reported subsequent treatments and the impact on relapse trends. RESULTS: A total of 50 patients (56% males, mean age 78 years) were included. With regard to clinical variables at diagnosis, statistical significance was found for Eastern Cooperative Oncology Group performance status 1 (46% of patients, p<0.0001), presence of three comorbidities (36% of patients, p<0.0001), World Health Organization grade 0 bleeding (46%, p=0.0001), and World Health Organization grade 1 bleeding (42%, p=0.0009). For bleeding sites, the most frequent were skin or mucosa (40%, p=0.0477). A decrease in platelet count was correlated with moderate or severe bleeding (ρ=−0.52, p=0.0001) and viscera or skin/mucosa + viscera site (ρ=−0.50, p=0.0002). Finally, a decreasing number of patients required treatment from first-line therapy to sixth (p<0.0001). Relapse was most frequent before second-line therapy (54%, p<0.0001) and less frequent before fivth and sixth (4%, p=0.0072; 2%, p=0.0027). CONCLUSION: ITP in older age poses considerable challenges, so specific management strategies should be considered to optimize outcomes. Our findings provide evidence of an inverse relationship between lines of therapy and timing of relapses. This study does not exclude the possibility that agents used after first-line therapy may have an impact on the response and modify the unfavorable course of ITP.
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spelling pubmed-74154582020-08-14 Clinical Phenotype and Response to Different Lines of Therapy in Elderly with Immune Thrombocytopenia: A Retrospective Study Mancuso, Salvatrice Carlisi, Melania Serra, Nicola Napolitano, Mariasanta Raso, Simona Consoli, Ugo Palazzolo, Roberto Lanza Cariccio, Maria Rosa Siragusa, Sergio J Blood Med Original Research PURPOSE: Insufficient knowledge of primary immune thrombocytopenia purpura (ITP) in the elderly, together with a lack of clinical trial data, has resulted in wide variation in treatments. Here, we present a study focused on clinical characteristics of ITP in older subjects at diagnosis integrated with the subsequent course of the disease and treatment history. METHODS: In a retrospective monoinstitutional study, we evaluated >65-year-old patients with primary ITP. Clinical characteristics at the time of diagnosis were described and analyzed. We aimed to delineate whether subsequent lines of therapy influenced the number of relapses. In addition to initial regimens, we reported subsequent treatments and the impact on relapse trends. RESULTS: A total of 50 patients (56% males, mean age 78 years) were included. With regard to clinical variables at diagnosis, statistical significance was found for Eastern Cooperative Oncology Group performance status 1 (46% of patients, p<0.0001), presence of three comorbidities (36% of patients, p<0.0001), World Health Organization grade 0 bleeding (46%, p=0.0001), and World Health Organization grade 1 bleeding (42%, p=0.0009). For bleeding sites, the most frequent were skin or mucosa (40%, p=0.0477). A decrease in platelet count was correlated with moderate or severe bleeding (ρ=−0.52, p=0.0001) and viscera or skin/mucosa + viscera site (ρ=−0.50, p=0.0002). Finally, a decreasing number of patients required treatment from first-line therapy to sixth (p<0.0001). Relapse was most frequent before second-line therapy (54%, p<0.0001) and less frequent before fivth and sixth (4%, p=0.0072; 2%, p=0.0027). CONCLUSION: ITP in older age poses considerable challenges, so specific management strategies should be considered to optimize outcomes. Our findings provide evidence of an inverse relationship between lines of therapy and timing of relapses. This study does not exclude the possibility that agents used after first-line therapy may have an impact on the response and modify the unfavorable course of ITP. Dove 2020-08-05 /pmc/articles/PMC7415458/ /pubmed/32801981 http://dx.doi.org/10.2147/JBM.S256620 Text en © 2020 Mancuso et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Mancuso, Salvatrice
Carlisi, Melania
Serra, Nicola
Napolitano, Mariasanta
Raso, Simona
Consoli, Ugo
Palazzolo, Roberto
Lanza Cariccio, Maria Rosa
Siragusa, Sergio
Clinical Phenotype and Response to Different Lines of Therapy in Elderly with Immune Thrombocytopenia: A Retrospective Study
title Clinical Phenotype and Response to Different Lines of Therapy in Elderly with Immune Thrombocytopenia: A Retrospective Study
title_full Clinical Phenotype and Response to Different Lines of Therapy in Elderly with Immune Thrombocytopenia: A Retrospective Study
title_fullStr Clinical Phenotype and Response to Different Lines of Therapy in Elderly with Immune Thrombocytopenia: A Retrospective Study
title_full_unstemmed Clinical Phenotype and Response to Different Lines of Therapy in Elderly with Immune Thrombocytopenia: A Retrospective Study
title_short Clinical Phenotype and Response to Different Lines of Therapy in Elderly with Immune Thrombocytopenia: A Retrospective Study
title_sort clinical phenotype and response to different lines of therapy in elderly with immune thrombocytopenia: a retrospective study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415458/
https://www.ncbi.nlm.nih.gov/pubmed/32801981
http://dx.doi.org/10.2147/JBM.S256620
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