Controversies in the treatment of immune thrombocytopenia

Adam Cuker, Douglas B. Cines, Cindy E. Neunert

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

Purpose of review We address three current controversies in management of immune thrombocytopenia (ITP): Should asymptomatic children with newly diagnosed ITP and severe thrombocytopenia be treated? Does intensification of up-front therapy in adults with newly diagnosed ITP impact long-term outcomes? Is splenectomy still the second-line treatment of choice in adults with chronic ITP? Recent findings Severe bleeding is rare in children with ITP. There is little evidence that the platelet count predicts or that treatment prevents severe bleeding in this population. Intensified treatment with high-dose dexamethasone and rituximab in adults with newly diagnosed ITP is associated with improved platelet responses at 6 and 12 months but greater toxicity compared with standard therapy. Rituximab and thrombopoietin receptor agonists have emerged as suitable alternatives to splenectomy for second-line management of adults with chronic ITP. Summary We generally observe children with newly diagnosed ITP and mild or no bleeding symptoms, irrespective of platelet count. We do not routinely use intensified up-front therapy in adults with newly diagnosed ITP. We discuss the advantages and disadvantages of splenectomy, rituximab, and thrombopoietin receptor agonists with our patients and make a joint decision that takes into consideration age, comorbidities, lifestyle, values, preferences, and financial considerations.

Original languageEnglish (US)
Pages (from-to)479-485
Number of pages7
JournalCurrent Opinion in Hematology
Volume23
Issue number5
DOIs
StatePublished - Sep 1 2016

Fingerprint

Idiopathic Thrombocytopenic Purpura
Splenectomy
Thrombopoietin Receptors
Therapeutics
Hemorrhage
Platelet Count
Thrombocytopenia
Dexamethasone
Life Style
Comorbidity
Blood Platelets

Keywords

  • Immune thrombocytopenia
  • management
  • treatment

ASJC Scopus subject areas

  • Hematology

Cite this

Controversies in the treatment of immune thrombocytopenia. / Cuker, Adam; Cines, Douglas B.; Neunert, Cindy E.

In: Current Opinion in Hematology, Vol. 23, No. 5, 01.09.2016, p. 479-485.

Research output: Contribution to journalReview article

Cuker, Adam ; Cines, Douglas B. ; Neunert, Cindy E. / Controversies in the treatment of immune thrombocytopenia. In: Current Opinion in Hematology. 2016 ; Vol. 23, No. 5. pp. 479-485.
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