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Pediatr Blood Cancer. 2018 Jan;65(1). doi: 10.1002/pbc.26736. Epub 2017 Aug 9.

Predictors of remission in children with newly diagnosed immune thrombocytopenia: Data from the Intercontinental Cooperative ITP Study Group Registry II participants.

Author information

1
Department of Pediatrics, Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorder Center, Emory University School of Medicine, Atlanta, Georgia.
2
Department of Pediatrics, Columbia University Medical Center, New York, New York.
3
Department of Pediatric Hematology/Oncology, Dana-Farber Boston Children's Cancer and Blood Disorder Center, Boston, Massachusetts.
4
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
5
Prof. Emeritus of the Medical Faculty, University of Basel, Switzerland.
6
Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
7
Division of Oncology/Hematology, University Children's Hospital, Basel, Switzerland.

Abstract

BACKGROUND:

Immune thrombocytopenia (ITP) during childhood spontaneously remits in up to 80% of children. Predictors of remission are not well understood.

PROCEDURE:

We analyzed data from Intercontinental Cooperative ITP Study Group (ICIS) Registry II, a large prospective cohort of children with ITP, to investigate factors that might predict remission.

RESULTS:

In ICIS Registry II, 705 patients had data collected through 12 months following diagnosis, with 383 patients having data available at 24 months as well. Younger age and pharmacologic treatment at diagnosis were significantly associated with disease resolution at 12 and 24 months (P < 0.0001 for both) as was bleeding at diagnosis (P < 0.0001 and P = 0.0213, respectively). Gender and platelet count at diagnosis were not significantly correlated with remission. In the multivariable analysis, remission at 12 months was associated with younger age, higher bleeding grade at diagnosis, and treatment with a combination of intravenous immunoglobulin (IVIG) and corticosteroids at diagnosis. Only younger age and treatment with IVIG and steroids in combination at diagnosis were associated with remission at 24 months. Patients <1 year of age had the highest odds of achieving remission at both 12 months (OR 4.7, 95% CI: 2.0-10.6) and 24 months (OR 7.0, 95% CI: 2.3-20.8).

CONCLUSIONS:

Younger age, bleeding severity at diagnosis, and initial treatment with a combination of corticosteroids and IVIG are associated with remission at 12 months in the ICIS Registry II. Patients <1 year of age have the highest likelihood of remission. The relationship of bleeding and treatment at diagnosis requires further study to clarify whether these are independent predictors of remission.

KEYWORDS:

ICIS; chronic ITP; immune thrombocytopenia; platelets; predictors

PMID:
28792679
DOI:
10.1002/pbc.26736
[Indexed for MEDLINE]

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