[ITP changes because of you] Issue 37

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

The "Chinese Guidelines for the Diagnosis and Treatment of Primary Immune Thrombocytopenia in Adults (2020 Edition)" pointed out that the dose of prednisone should be reduced as soon as possible after the onset of effect, and discontinued within 6 to 8 weeks.

Let us hear the experts' opinions on the treatment goals of ITP patients and the choice of follow-up treatment options for patients with poor first-line hormone control

Professor Jing Yu

• Associate Professor, Chief Physician, Department of Hematology, Chinese People's Liberation Army General Hospital, Doctoral and Master Supervisor

• Member of the Standing Committee of the Professional Committee of Hematology Precision Diagnosis and Treatment of China Research Hospital Association

• Member of the Myeloid Oncology Group of the Hematology and Oncology Professional Committee of the Chinese Anti-Cancer Association

• Member of the Hematology Branch of the Chinese Geriatrics Association

• Undertook one sub-project of the 13th Five-Year Project of the Army, one sub-project of the National Science and Technology Major Project, one provincial and ministerial-level project, one academy-level project, and 2 national-level projects.
  
  
  
  

  Gender: Female

  Age: 77

  Initial platelet level: 25×10 ⁹ /L 

  Hormone Poor Situation: Hormone Dependence

  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.

  
  

  Duration of medication: 4 weeks

  
  

  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 25 × 10 ⁹ /L, and after 9 weeks of eltrombopag treatment, the platelet count increased to 113 × 10 ⁹ /L, achieving a complete response, that is, platelet count ≥ 100 × 10 ⁹ /L, and no bleeding

  
  

  Professor Hu Xiaojing

  • Deputy Chief Physician, Department of Hematologic Lymphoma, Dongguan People's Hospital
  • Member of the Professional Committee of Hematology of Guangdong Women Physician Association
  • Member of the Precision Hematology Branch of the Guangdong Precision Medicine Application Society
  • Good at leukemia, lymphoma and other blood tumor diseases diagnosis
  
  expert concept

  For patients with poor first-line hormone control, what factors should be considered in the subsequent selection of treatment options, Professor Hu Xiaojing believes: "Poor hormone therapy generally refers to ineffectiveness or hormone dependence after hormone therapy, so ITP patients who are newly diagnosed with hormone therapy must be It is necessary to standardize treatment, but in clinical practice, there are often many patients whose treatment effect is not good due to irregular hormone treatment, but they are mistaken for ineffective hormone treatment.
  Such patients should be treated differently to identify the ineffective hormone treatment in the true sense, and as soon as possible Take second-line therapy
  .
  
  ”
  

  
  Clinical practice sharing

  Case 2 basic information:

  Sex: Male

  Age: 68 

  Initial platelet level: 50×10 ⁹ /L

  Hormone Poor Situation: Hormone Dependence

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

  Drug name and dosage: Prednisone 50mg qd

  Duration of medication: 2 weeks

  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 50 × 10 ⁹ /L, and after 11 weeks of eltrombopag treatment, the platelet count increased to 112 × 10 ⁹ /L, achieving a complete response, that is, platelet count ≥ 100 × 10 ⁹ /L, and no bleeding
  .
  

  Professor Hou Jinxiao

  • Doctor, Deputy Chief Physician, Department of Hematology, Second Affiliated Hospital of Anhui Medical University 

  • Member of the 7th Red Science Group of Hematology Branch of Anhui Medical Association

  • Member of the Professional Committee of Hematology Immunity and Targeted Therapy of Anhui Anti-Cancer Association

  • Good at diagnosis and treatment of multiple myeloma, leukemia, lymphoma and other hematological malignancies

  
  expert concept

  Regarding the unmet needs of first-line hormone therapy for ITP, Professor Hou Jinxiao believes: "The first-line use of hormones requires close monitoring.
  Long-term use of hormones in patients can cause problems such as infection and peptic ulcers.
  Patients with advanced age, diabetes, glaucoma and other patients should use hormones with caution.
  
  .
  
  ”
  

  
  Clinical practice sharing

  Case 3 basic information:

  Sex: Male

  Age: 37

  Initial platelet level: 11×10 ⁹ /L 

  Hormone Poor Situation: Hormone Dependence

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

  Drug name and dosage: Prednisone 50mg qd

  Duration of medication: 6 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 11 × 10 ⁹ /L, and after 11 weeks of eltrombopag (50 mg, qd) treatment, the platelet count increased to 79 × 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 Zhou Wenhua

  • Master of Medicine, Attending Physician, Department of Hematology, The First Affiliated Hospital of Nanchang University
  • Member of the Hematology Branch of Jiangxi Health Care Association
  • Committee of Hematology Branch of Jiangxi Integrative Medicine Association
  
  expert concept

  Regarding the treatment goals of ITP patients, Professor Zhou Wenhua believes: "The treatment goals of ITP patients are to increase the platelet count to a safe level, reduce the risk of bleeding, improve the patient's quality of life, and minimize the adverse drug reactions
  .
  
  "
  

  
  Clinical practice sharing

  Case 4 Basic information:

  Gender: Female

  Age: 67

  Initial platelet level: 32×10 ⁹ /L

  Hormone Poor Situation: Hormone Dependence

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

  Drug name and dosage: Prednisone 40mg

  Duration of medication: 4 weeks 

  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 32 × 10 ⁹ /L, and after 9 weeks of Eltrombopag (50 mg, qd) treatment, the platelet count increased to 142 × 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.
  Witkowski M, et al.
  Eur J Haematol.
  2019 Dec;103(6):531-541.
  

  
  

  The MCC number REV2208900 is valid on 2023-08-11, and the information expires and is deemed invalid
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  Edit: September Typesetting: siqili Execution: moly

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