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Am J Hematol. 2018 Jan;93(1):58-64. doi: 10.1002/ajh.24935. Epub 2017 Nov 9.

Alternate use of thrombopoietin receptor agonists in adult primary immune thrombocytopenia patients: A retrospective collaborative survey from Italian hematology centers.

Author information

1
Hematology and Oncology Department, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan.
2
Hematology and Transplant Unit, ASST San Gerardo Hospital, Monza.
3
Hematology and Cell Biology Department, La Sapienza University, Rome.
4
Hematology Department, Catholic University, Rome.
5
Hematology Department, Careggi University Hospital, Florence.
6
Hematology Department, San Bortolo Hospital, Vicenza.
7
Hematology and Transplant Department, Policlinico Consorziale, Bari.
8
"L. e A. Seragnoli" Hematology and Oncology Institute, Sant'Orsola Hospital, Bologna.
9
Hematology and Transplant Department, Federico II University, Naples.
10
Hematology Department, G.Garibaldi Hospital, Catania.
11
"Angelo Bianchi Bonomi" Haemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
12
Hematology Department, DISM, S. M. Misericordia University Hospital, Udine.
13
Hematology Department, ASST. Spedali Civili, Brescia.
14
Hematology and Clinical Immunology Department, University Hospital, Padua.
15
Hematology Department, Cardarelli Hospital, Naples.
16
Oncohematology Department, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, Milan.
17
Hematology Department, "Sette laghi" University Hospital, Varese.
18
Biostatistics, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan.

Abstract

Sequential use of the TPO-RAs romiplostim and eltrombopag in ITP patients failing either agent was retrospectively evaluated to assess efficacy and impact of clinical characteristics on outcome. Patients were grouped into 5 categories: efficacy issues: 1st TPO-RA failure; loss of response; non-efficacy issues: platelet fluctuations; patient's preference; adverse event development. Either one TPO-RA sequence was analyzed at 3 month and at last follow-up. 106/546 patients on TPO-RA underwent switch and 65% achieved, regained or maintained a short- term response independent of switch sequence, gender or age; lower response rates were associated with lines of previous therapy; disease duration lowers probability to respond. Clinically, patients switched for efficacy issue did not differ from those switched for non-efficacy issues. Response was achieved/regained in 57.8% of patients switched for efficacy issues, the lowest response rates were observed in non-responders to 1st TPO-RA; 80% of patients switched for non-efficacy issues maintained a response. Platelet fluctuation resolved in 44.4%. Of the 49 patients evaluable for long-term outcome, 27 were in response on therapy; 16 discontinued the TPO-RA for reasons other than efficacy, while only 6 were non responders. We confirm the efficacy of TPO-RA switch; once achieved, response to the 2nd TPO-RA seems durable.

PMID:
28983953
DOI:
10.1002/ajh.24935
[Indexed for MEDLINE]
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