期刊
BRITISH JOURNAL OF HAEMATOLOGY
卷 184, 期 3, 页码 424-430出版社
WILEY
DOI: 10.1111/bjh.15668
关键词
ITP; immune thrombocytopenia; TPO-receptor agonists; toxicity; older age
类别
资金
- BolognAIL
We analysed the impact of older age on the management of immune thrombocytopenia (ITP) in 465 adult patients diagnosed between 1995 and 2017 and followed at our institution for a minimum of 12 months. Over a follow-up of 4248 patient-years, front-line corticosteroids therapy was required in 334 patients (71 center dot 8%), mainly (85 center dot 3%) within 1 year from diagnosis. Need for first-, second- and third-line therapy was comparable in younger and older (age >= 65 years, n = 154) patients. Older patients presented more frequently with severe haemorrhages, started therapy with a higher platelet count and received lower dose front-line corticosteroids; thereafter, they were preferentially treated with mild immunosuppressive therapies/thrombopoietin-receptor agonists. Conversely, younger patients were more frequently treated with rituximab and splenectomy, achieving higher rates of complete responses. Incidence rates of >= grade 2 complications were: 2 center dot 87 (haemorrhages), 1 center dot 55 (infections) and 0 center dot 66 (thromboses) per 100 patient-years. Older age (P = 0 center dot 01) and active haemorrhages at diagnosis (P = 0 center dot 01) significantly predicted grade >= 2 haemorrhages during follow-up. Older age (P = 0 center dot 01), male gender (P = 0 center dot 01), and thrombopoietin receptor agonist use (P = 0 center dot 02) were significantly associated with a higher probability of thrombosis over time. Older age is a significant driver of diagnostic/therapeutic strategy in ITP resulting in different responses and complications rates.
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