[ITP changed because of you] Issue 39

The content of this article is for reading only by healthcare professionals

^{The clinical goal of} ITP therapy is to resolve bleeding events or prevent severe bleeding by providing adequate hemostasis

Hormone ineffective means that platelet count is less than 30×10 ⁹ /L after hormone therapy, or platelet count is less than 2 times of the basal value, or there is bleeding

The "Chinese Guidelines for the Diagnosis and Treatment of Primary Immune Thrombocytopenia in Adults (2020 Edition)" pointed out that patients who are ineffective or relapsed after high-dose dexamethasone treatment can be repeated for 1 cycle (1 cycle 4d); prednisone treatment within 2 weeks Ineffective patients should stop as soon as ^possible1

Let's hear what the experts have to say about treatment goals for ITP patients, unmet needs for first-line hormone therapy, and more

Professor Li Limin

• Deputy Chief Physician, Department of Hematology, Southern University of Science and Technology Hospital 

• Corresponding editorial board member of "Chinese Journal of Cell and Stem Cell"

• Member of the Hematopoietic Stem Cell Transplantation Group of the Chinese Society of Hematology

• Youth Committee Member of Internal Medicine Branch of Chinese Medical Association

• Member of the Children's Hematology and Tumor Special Committee of the Chinese Medical Doctor Association

• Executive Director of Traditional Chinese Medicine Working Committee of General Hospital

• Member of the Fifth Professional Committee of Cancer Clinical Chemotherapy of China Anti-Cancer Association

• Member of the Central Committee of Children's Oncology, Chinese Research Hospital Association

• Vice Chairman of Hematology Branch of Heilongjiang Medical Association

• Technical editorial board member of the 8th and 9th editions of internal medicine digital textbooks

Sex: Male

Age: 40 years old

Initial platelet level: 17×10 ⁹ /L 

Hormone insufficiency: Hormone ineffective

The specific medication regimen and medication duration of the previous case (before the use of second-line drugs):

Drug name and dosage: Prednisone 70mg

Duration of medication: 1 week

Table 1 Case 1 follow-up and efficacy evaluation records

Note: Eltrombopag is administered once daily (qd)

Figure 1 Follow-up and efficacy evaluation records of case 1

The patient's initial platelet count was 17 × 10 ⁹ /L, and after 8 weeks of eltrombopag (50 mg, qd) treatment, the platelet count increased to 105 × 10 ⁹ /L, achieving a complete response, that is, platelet count ≥ 100 × 10 ⁹ /L, and no bleeding
.

Professor Peng Jie

• Deputy Chief Physician, Doctor of Hematology, Department of Hematology, Xiangya Hospital, Central South University

• Member of the Thrombosis and Hemostasis Group of the Chinese Society of Hematology

• Director of China Hemophilia Youth Collaborative Group

• Member of the Standing Committee of the Hemophilia Group of the China Rare Disease Alliance

• Secretary of Hunan Hemorrhagic Disease Collaborative Group

• Member of Hunan Geriatrics Hematology Branch

• Young and middle-aged editorial board member of Xiangya Medical Journal

• Member of the Committee of Thrombosis and Hemostasis Branch of China Research Hospital Association, member of Hunan-Hubei Blood Alliance

• Changsha Friendship Hemophilia Care Center Medical Consultant

• Visiting Scholar at MD Anderson Cancer Centre, University of Texas, Texas

• Graduated from the Department of Clinical Medicine of Hunan Medical University in June 1999, and engaged in clinical work in the Department of Hematology, Xiangya Hospital, Central South University after graduation

• From 2003 to 2006, and from 2011 to 2017, he successively studied for a master's degree and a doctoral degree, and obtained the corresponding degree

• Since 2009, he has been working part-time in the diagnosis and treatment of Xiangya Hemophilia Diagnosis and Treatment Center, and was awarded the medical consultant of Changsha Friendship Hemophilia Care Center

• From 2014 to 2015, he was engaged in hematology research at MD Anderson Cancer Centre, University of Texas, USA.
  His clinical work is good at diagnosis and treatment of hematological malignancies, hemorrhagic and thrombotic diseases.
  

• The first author published 12 articles, including 6 SCI articles

• Participated in the revision of "Chinese Guidelines for the Diagnosis and Treatment of Primary Immune Thrombocytopenia in Adults (2020 Edition)"; participated in the compilation of "Deng Jiadong Clinical Hematology Second Edition", "Concise Experimental Hematology", "Diagnosis and Treatment of Geriatric Hematology" ", "Xiangya Clinical Skills Training Course" and other bibliography

• Participated in 3 projects of the National Natural Science Foundation of China, 3 projects planned by the Provincial Department of Science and Technology, and 1 scientific research project of the Provincial Department of Health

Regarding the treatment goals of ITP patients, Professor Peng Jie believes: "The treatment goals of ITP patients are to reduce the bleeding risk, rapidly increase and stabilize the patient's platelet count
.

"

Case 2 basic information:

Sex: Male

Age: 42 

Initial platelet level: 31×10 ⁹ /L

Hormone insufficiency: Hormone ineffective

The specific medication regimen and medication duration of the previous case (before the use of second-line drugs):

Drug name and dose: methylprednisolone 40mg qd

Duration of medication: 1 week

Table 2 Case 2 follow-up and efficacy evaluation records

Note: Both corticosteroids and eltrombopag are administered once daily (qd)
.

Figure 2 Follow-up and efficacy evaluation records of case 2

The patient's initial platelet count was 31 × 10 ⁹ /L, and after 11 weeks of Eltrombopag (50 mg, qd) treatment, the platelet count increased to 181 × 10 ⁹ /L, achieving a complete response, that is, platelet count ≥ 100 × 10 ⁹ /L, and no bleeding
.

Professor He Qun

• Deputy Chief Physician, Department of Hematology, Xiangya Hospital, Central South University

• Member of the Professional Committee of Hematology of Hunan Medical Association

• Member of the Lymphoma Professional Committee of Hunan Anti-Cancer Association

• Registered Physician of China Charity Federation GIPA Project

• Executive Director of Hunan Health Service Industry Association

Regarding the treatment goals of ITP patients, Professor He Qun believes: "The treatment goals of ITP patients are to rapidly increase the platelet count, improve symptoms such as anxiety and fatigue, and improve the patient's quality of life
.

"

Case 3 basic information:

Gender: Female

Age: 49

Initial platelet level: 40×10 ⁹ /L 

Hormone insufficiency: Hormone ineffective

The specific medication regimen and medication duration of the previous case (before the use of second-line drugs):

Drug name and dose: methylprednisolone 40mg qd

Duration of medication: 2 weeks

Table 3 Case 3 follow-up and efficacy evaluation records

Note: Both corticosteroids and eltrombopag are administered once daily (qd)
.

Figure 3 Follow-up and efficacy evaluation records of case 3

The patient's initial platelet count was 40 × 10 ⁹ /L, and after 9 weeks of Eltrombopag (50 mg, qd) treatment, the platelet count increased to 137 × 10 ⁹ /L, achieving a complete response, that is, platelet count ≥ 100 × 10 ⁹ /L, and no bleeding
.

Professor Chen Kankan

• Deputy Chief Physician, Department of Hematology, Huaian First People's Hospital

• Master tutor of Nanjing Medical University

• Member of Thrombosis and Hemostasis Group, Blood Branch of Jiangsu Medical Association

• Member of Hemostasis and Thrombosis Group, Hematology Branch of Jiangsu Research Hospital Association

• Member of Health Management Professional Committee of Jiangsu Preventive Medicine Association

• Member of the Geriatric Chronic Disease Health Management Branch of Jiangsu Geriatrics Association

• Member and Secretary of the Blood Branch of Huaian Medical Association

• Vice Chairman of the Medical Information Branch of Huaian Medical Association

Regarding the unmet needs of first-line hormone therapy for ITP, Professor Chen Kankan believes: "30% of patients with hormone therapy are ineffective, intolerant, and have poor safety; hormones increase platelets slowly and cannot be maintained after drug withdrawal.
The level of platelets has large adverse reactions; currently, first-line hormones are often combined with second-line drug therapy
.

”

Case 4 Basic information:

Sex: Male

Age: 54

Initial platelet level: 6×10 ⁹ /L

Hormone insufficiency: Hormone ineffective

The specific medication regimen and medication duration of the previous case (before the use of second-line drugs):

Drug name and dosage: Dexamethasone 40mg

Duration of medication: less than 1 week

Table 4 Case 4 follow-up and efficacy evaluation records

Note: Both corticosteroids and eltrombopag are administered once daily (qd)
.

Figure 4 Follow-up and efficacy evaluation records of case 4

The patient's initial platelet count was 6 × 10 ⁹ /L, and after 11 weeks of eltrombopag (25 mg, qd) treatment, the platelet count increased to 78 × 10 ⁹ /L, and the treatment was effective, that is, the platelet count after treatment ≥ 30×10 ⁹ /L, at least 2 times higher than the basal platelet count, and no bleeding
.

references

1.
Hou Ming, Hu Yu.
Chinese Journal of Hematology, 2020(8):617-623.

2.
Frederiksen, H.
et al.
Blood.
1999;94:909-913.

3.
Provan, D.
et al.
Blood Adv.
2019;3:3780-3817.

4.
Cuker A, et al.
Res Pract Thromb Haemost.
2021;5(6):e12592.

The MCC number REV22071246 is valid from 2023-07-17, and the information expires and is deemed invalid
.

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