[ITP changes because of you] Issue 35

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^{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 Guo Xinhong

• Deputy Chief Physician, Professor, Doctoral Supervisor, Hematology Center, First Affiliated Hospital of Xinjiang Medical University

• Member of the Hemostasis and Thrombosis Group of the Hematology Branch Committee of the Chinese Medical Association

• Member of the Committee of Hematology Branch of Chinese Geriatrics Association

• Member of the Professional Committee of Hematology Rehabilitation of Chinese Association of Rehabilitation Medicine

• Lymphoma Group of the Fifth Hematology and Tumor Professional Committee of China Anti-Cancer Association

• The 9th National Youth Committee of the Society of Hematology

• Member of the 4th Hematology Branch of Xinjiang Medical Association

• Deputy Chairman of the Lymphoma Professional Committee of Xinjiang Anti-Cancer Association

• Member of the Cancer Prevention and Treatment Professional Society of Xinjiang Gerontology Society

• Director of the Blood Immunity Professional Committee of the Xinjiang Society of Immunology

Gender: Female

Age: 27

Initial platelet level: 8×10 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 qd

Duration of medication: less than 1 week

Table 1 Case 1 follow-up and efficacy evaluation records

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

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

The patient's initial platelet count was 8 × 10 ⁹ /L, and after 9 weeks of eltrombopag (50mg, qd) treatment, the platelet count increased to 90 × 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
.

Professor Liu Chunshui

• Chief Physician and Postgraduate Supervisor of the Department of Hematology, Oncology Center, First Hospital of Jilin University

• Member of Hematology Branch of Jilin Province and Changchun Medical Association

• Member of the Professional Committee of Precision Medicine and Oncology MDT in Chinese Research Hospitals

• Member of Lymphoma Branch of China Medical Education Association

• Director of the Blood Disease Branch of the Chinese Association for Ethnic Medicine

• Good at chronic myeloid leukemia, lymphoma, plasma cell disease

• Served as the responsible doctor for the chronic myeloid leukemia targeted drug assistance project

• Responsible for a number of clinical studies on chronic myeloid leukemia

• Won the National Ten-Year Special Contribution Award, Outstanding Contribution Award, and Outstanding Doctor Award issued by China Charity Federation

Regarding the treatment goals of ITP patients, Professor Liu Chunshui believes: "The treatment goals of ITP patients are to relieve or prevent bleeding, increase the patient's platelet count, and improve the patient's quality of life
.

"

Case 2 basic information:

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: dexamethasone 40mg qd; gamma globulin 0.
4g/kg

Duration of medication: 4 weeks

Table 2 Case 2 follow-up and efficacy evaluation records

Note: Eltrombopag is administered once daily (qd)
.

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

The patient's initial platelet count was 13 × 10 ⁹ /L, and after 12 weeks of eltrombopag (50 mg, qd) treatment, the platelet count increased to 55 × 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
.

Professor Deng Mingyang

• Deputy Chief Physician, Associate Professor, Second Xiangya Hospital, Central South University Doctor of Medicine

• Member of the Professional Committee of Hematology, Hunan Geriatrics Association

• Member of the Professional Committee of Hematology, Hunan Association of Traditional Chinese Medicine and Integrative Medicine

• Member of the European Society for Blood and Marrow Transplantation

• Member of Hematopoietic Stem Cell Transplantation Group of Hunan Hematology Branch of Chinese Medical Association

• Member of the bone marrow failure disease assistance group of the Hunan Provincial Hematology Branch of the Chinese Medical Association, Peking University People's Hospital in 2011 for further training in hematopoietic stem cell transplantation

• Good at hematopoietic stem cell transplantation, lymphoma, multiple myeloma, aplastic anemia diagnosis and treatment

• Participated in a number of National Natural Science Foundation of China, presided over 2 provincial natural science funds, published more than 30 academic papers

Regarding the treatment goals of ITP patients, Professor Deng Mingyang believes: "The treatment goals of ITP patients are to rapidly increase and stabilize platelet counts, reduce the risk of bleeding, improve symptoms such as anxiety and fatigue, and improve the quality of life
.

"

Case 3 basic information:

Gender: Female

Age: 64

Initial platelet level: 16×10 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 3 Case 3 follow-up and efficacy evaluation records

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

The patient's initial platelet count was 16 × 10 ⁹ /L, and after 11 weeks of eltrombopag treatment, the platelet count increased to 161 × 10 ^{9 /} L, achieving a complete response, that is, platelet count ≥ 100 × 10 ⁹ /L, and no bleeding
.

Professor Zhao Wenbo

• Deputy Chief Physician, Department of Hematology, Shandong Provincial Hospital, Doctor of Medicine and Master's Tutor

• Member of the Chinese Anti-Cancer Association Branch of Integrated Traditional Chinese and Western Medicine

• Member of Hematology Branch of Shandong Medical Association

• Undertook 1 national project and 3 provincial and ministerial projects

Regarding the unmet needs of first-line hormone therapy for ITP, Professor Zhao Wenbo believes: "After hormone therapy is ineffective, platelet count is less than 30 × 10 ⁹ /L, and the risk of bleeding increases.
It is necessary to quickly increase the platelet level to ensure patient safety
.

"

Case 4 Basic information:

Sex: Male

Age: 45

Initial platelet level: 8×10 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 10mg qd

Duration of medication: 2 weeks 

Table 4 Case 4 follow-up and efficacy evaluation records

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

The patient's initial platelet count was 8 × 10 ⁹ /L, and after 9 weeks of eltrombopag (25 mg, qd) treatment, the platelet count increased to 108 × 10 ⁹ /L, achieving a complete response, that is, platelet count ≥ 100 × 10 ⁹ /L, 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.

MCC No.
REV2207523 Validity 2023-07-08

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