title: Sustained remission of chronic immune thrombocytopenia after discontinuation of treatment with thrombopoietin-receptor agonists in adults.
abstract: Thrombopoietin-receptor agonists (TPO-RAs) are highly effective in immune thrombocytopenia (ITP). Recently, reports of sustained remission after TPO-RA discontinuation in adult ITP have been reported. We aimed to describe the subset of patients in whom TPO-RA therapy may induce a durable response. We retrospectively analyzed all of our adult ITP patients treated with TPO-RAs, and focused on patients with discontinued TPO-RA therapy due to treatment response. Forty-six relapsed or refractory ITP patients were treated with TPO-RAs. In 11 of these cases, TPO-RA therapy (seven romiplostim; four eltrombopag) was stopped after achieving treatment response. No side effects of TPO-RAs were observed. These patients were pretreated with 1-3 therapy lines plus splenectomy in six patients prior to TPO-RA administration. None of these patients experienced disease relapse after therapy discontinuation over a median follow-up of 33 months (16-54). Substantial proportion of ITP patients receiving TPO-RAs can maintain a durable response after treatment discontinuation. Sustained ITP remission probably does not depend on previous treatment, splenectomy, or disease duration.
authors.affiliation: Department of Internal Medicine-Hematology and Oncology, University Hospital and Masaryk University, Jihlavská 20, 62500, Brno, Czech Republic.
authors.forename: Libor
authors.initials: L
authors.lastname: Červinek
authors.forename: Jiří
authors.initials: J
authors.lastname: Mayer
authors.forename: Michael
authors.initials: M
authors.lastname: Doubek
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy* / Q000378:metabolism; D011961:Receptors, Fc / Q000627:therapeutic use*; D053628:Receptors, Thrombopoietin / Q000819:agonists*; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D013926:Thrombopoietin / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D011961:Receptors, Fc; D053628:Receptors, Thrombopoietin; D011993:Recombinant Fusion Proteins; D013926:Thrombopoietin; C488777:romiplostim
references.citation: Eur J Haematol. 2013 Nov;91(5):423-36
references.pmid: 23927437
references.citation: Semin Hematol. 2007 Oct;44(4 Suppl 5):S12-23
references.pmid: 18096468
references.citation: Blood. 2009 Mar 12;113(11):2386-93
references.pmid: 19005182
references.citation: Br J Haematol. 2003 Feb;120(4):574-96
references.pmid: 12588344
references.citation: Br J Haematol. 2013 Feb;160(4):538-46
references.pmid: 23278590
references.citation: N Engl J Med. 2007 Nov 29;357(22):2237-47
references.pmid: 18046028
references.citation: Lancet. 2008 Feb 2;371(9610):395-403
references.pmid: 18242413
references.citation: Transfusion. 2013 Nov;53(11):2807-12
references.pmid: 23451917
references.citation: Br J Haematol. 2014 Jun;165(6):865-9
references.pmid: 24725224
references.citation: Blood. 2010 Jan 14;115(2):168-86
references.pmid: 19846889
references.citation: Blood. 2009 Mar 5;113(10 ):2161-71
references.pmid: 18981291