Management of elderly patients with immune thrombocytopenia: Real-world evidence from 451 patients older than 60 years

Francesca Palandri, Cristina Santoro, Monica Carpenedo, Silvia Cantoni, Wilma Barcellini, Giuseppe Carli, Valentina Carrai, Elena Rossi, Elena Rivolti, Alessandro Lucchesi, Francesco Rotondo, Erminia Baldacci, Giuseppe Auteri, Emanuele Sutto, Christian Di Pietro, Lucia Catani, Daniela Bartoletti, Valerio De Stefano, Marco Ruggeri, Maria Gabriella MazzucconiMichele Cavo, Francesco Rodeghiero, Nicola Vianelli

Research output: Contribution to journalArticle

Abstract

Introduction: Primary Immune thrombocytopenia (ITP) in the elderly is a major clinical challenge which is increasingly frequent due to global ageing population. Materials and methods: To describe baseline ITP features, management, and outcome, a centralized electronic database was established, including data of 451 patients aged ≥60 years that were treated from 2000 onwards and were observed for ≥1 year (total observation of 2704 patient-years). Results: At ITP diagnosis, median age was 71.1 years (age ≥ 75: 42.8%); 237 (53.9%) patients presented with haemorrhages (grade ≥ 3: 7.5%). First-line therapy included prednisone (82.9%), dexamethasone (14.6%), thrombopoietin-receptor agonists (TRAs, 1.3%), and oral immunosuppressive agents (1.1%). Prednisone starting dose ≥1 mg/kg/d (p = .01) and dexamethasone 40 mg/d (p < .001) were mainly reserved to patients aged 60–74, who were more treated with rituximab (RTX, p = .02) and splenectomy (p = .03) second-line. Overall response rates to first and second-line therapies were 83.8% and 84.5%, respectively, regardless of age and treatment type/dose. A total of 178 haemorrhages in 101 patients (grade ≥ 3: n. 52, 29.2%; intracranial in 6 patients), 49 thromboses in 43 patients (grade ≥ 3: n. 26, 53.1%) and 115 infections in 94 patients (grade ≥ 3: n. 23, 20%) were observed during follow-up. Incidence rates of complications per 100 patient-years were: 4.5 (haemorrhages, grade ≥ 3: 1.7), 1.7 (thromboses, grade ≥ 3: 0.9), and 3.9 (infections, grade ≥ 3: 0.7). TRAs use were associated with reduced risk of bleeding and infections, while cardiovascular risk factors (particularly, diabetes) significantly predicted thromboses and infections. Conclusions: Age-adapted treatment strategies are required in elderly and very elderly patients.

Original languageEnglish
Pages (from-to)88-95
Number of pages8
JournalThrombosis Research
Volume185
DOIs
Publication statusPublished - Jan 2020

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Idiopathic Thrombocytopenic Purpura
Hemorrhage
Thrombosis
Prednisone
Dexamethasone
Cardiovascular Infections
Thrombopoietin Receptors
Infection
Splenectomy
Therapeutics
Immunosuppressive Agents
Observation
Databases

Keywords

  • Elderly
  • Immune thrombocytopenia
  • ITP
  • Toxicity
  • TPO-receptor agonists

ASJC Scopus subject areas

  • Hematology

Cite this

Management of elderly patients with immune thrombocytopenia : Real-world evidence from 451 patients older than 60 years. / Palandri, Francesca; Santoro, Cristina; Carpenedo, Monica; Cantoni, Silvia; Barcellini, Wilma; Carli, Giuseppe; Carrai, Valentina; Rossi, Elena; Rivolti, Elena; Lucchesi, Alessandro; Rotondo, Francesco; Baldacci, Erminia; Auteri, Giuseppe; Sutto, Emanuele; Di Pietro, Christian; Catani, Lucia; Bartoletti, Daniela; De Stefano, Valerio; Ruggeri, Marco; Mazzucconi, Maria Gabriella; Cavo, Michele; Rodeghiero, Francesco; Vianelli, Nicola.

In: Thrombosis Research, Vol. 185, 01.2020, p. 88-95.

Research output: Contribution to journalArticle

Palandri, F, Santoro, C, Carpenedo, M, Cantoni, S, Barcellini, W, Carli, G, Carrai, V, Rossi, E, Rivolti, E, Lucchesi, A, Rotondo, F, Baldacci, E, Auteri, G, Sutto, E, Di Pietro, C, Catani, L, Bartoletti, D, De Stefano, V, Ruggeri, M, Mazzucconi, MG, Cavo, M, Rodeghiero, F & Vianelli, N 2020, 'Management of elderly patients with immune thrombocytopenia: Real-world evidence from 451 patients older than 60 years', Thrombosis Research, vol. 185, pp. 88-95. https://doi.org/10.1016/j.thromres.2019.11.026
Palandri, Francesca ; Santoro, Cristina ; Carpenedo, Monica ; Cantoni, Silvia ; Barcellini, Wilma ; Carli, Giuseppe ; Carrai, Valentina ; Rossi, Elena ; Rivolti, Elena ; Lucchesi, Alessandro ; Rotondo, Francesco ; Baldacci, Erminia ; Auteri, Giuseppe ; Sutto, Emanuele ; Di Pietro, Christian ; Catani, Lucia ; Bartoletti, Daniela ; De Stefano, Valerio ; Ruggeri, Marco ; Mazzucconi, Maria Gabriella ; Cavo, Michele ; Rodeghiero, Francesco ; Vianelli, Nicola. / Management of elderly patients with immune thrombocytopenia : Real-world evidence from 451 patients older than 60 years. In: Thrombosis Research. 2020 ; Vol. 185. pp. 88-95.
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T1 - Management of elderly patients with immune thrombocytopenia

T2 - Real-world evidence from 451 patients older than 60 years

AU - Palandri, Francesca

AU - Santoro, Cristina

AU - Carpenedo, Monica

AU - Cantoni, Silvia

AU - Barcellini, Wilma

AU - Carli, Giuseppe

AU - Carrai, Valentina

AU - Rossi, Elena

AU - Rivolti, Elena

AU - Lucchesi, Alessandro

AU - Rotondo, Francesco

AU - Baldacci, Erminia

AU - Auteri, Giuseppe

AU - Sutto, Emanuele

AU - Di Pietro, Christian

AU - Catani, Lucia

AU - Bartoletti, Daniela

AU - De Stefano, Valerio

AU - Ruggeri, Marco

AU - Mazzucconi, Maria Gabriella

AU - Cavo, Michele

AU - Rodeghiero, Francesco

AU - Vianelli, Nicola

PY - 2020/1

Y1 - 2020/1

N2 - Introduction: Primary Immune thrombocytopenia (ITP) in the elderly is a major clinical challenge which is increasingly frequent due to global ageing population. Materials and methods: To describe baseline ITP features, management, and outcome, a centralized electronic database was established, including data of 451 patients aged ≥60 years that were treated from 2000 onwards and were observed for ≥1 year (total observation of 2704 patient-years). Results: At ITP diagnosis, median age was 71.1 years (age ≥ 75: 42.8%); 237 (53.9%) patients presented with haemorrhages (grade ≥ 3: 7.5%). First-line therapy included prednisone (82.9%), dexamethasone (14.6%), thrombopoietin-receptor agonists (TRAs, 1.3%), and oral immunosuppressive agents (1.1%). Prednisone starting dose ≥1 mg/kg/d (p = .01) and dexamethasone 40 mg/d (p < .001) were mainly reserved to patients aged 60–74, who were more treated with rituximab (RTX, p = .02) and splenectomy (p = .03) second-line. Overall response rates to first and second-line therapies were 83.8% and 84.5%, respectively, regardless of age and treatment type/dose. A total of 178 haemorrhages in 101 patients (grade ≥ 3: n. 52, 29.2%; intracranial in 6 patients), 49 thromboses in 43 patients (grade ≥ 3: n. 26, 53.1%) and 115 infections in 94 patients (grade ≥ 3: n. 23, 20%) were observed during follow-up. Incidence rates of complications per 100 patient-years were: 4.5 (haemorrhages, grade ≥ 3: 1.7), 1.7 (thromboses, grade ≥ 3: 0.9), and 3.9 (infections, grade ≥ 3: 0.7). TRAs use were associated with reduced risk of bleeding and infections, while cardiovascular risk factors (particularly, diabetes) significantly predicted thromboses and infections. Conclusions: Age-adapted treatment strategies are required in elderly and very elderly patients.

AB - Introduction: Primary Immune thrombocytopenia (ITP) in the elderly is a major clinical challenge which is increasingly frequent due to global ageing population. Materials and methods: To describe baseline ITP features, management, and outcome, a centralized electronic database was established, including data of 451 patients aged ≥60 years that were treated from 2000 onwards and were observed for ≥1 year (total observation of 2704 patient-years). Results: At ITP diagnosis, median age was 71.1 years (age ≥ 75: 42.8%); 237 (53.9%) patients presented with haemorrhages (grade ≥ 3: 7.5%). First-line therapy included prednisone (82.9%), dexamethasone (14.6%), thrombopoietin-receptor agonists (TRAs, 1.3%), and oral immunosuppressive agents (1.1%). Prednisone starting dose ≥1 mg/kg/d (p = .01) and dexamethasone 40 mg/d (p < .001) were mainly reserved to patients aged 60–74, who were more treated with rituximab (RTX, p = .02) and splenectomy (p = .03) second-line. Overall response rates to first and second-line therapies were 83.8% and 84.5%, respectively, regardless of age and treatment type/dose. A total of 178 haemorrhages in 101 patients (grade ≥ 3: n. 52, 29.2%; intracranial in 6 patients), 49 thromboses in 43 patients (grade ≥ 3: n. 26, 53.1%) and 115 infections in 94 patients (grade ≥ 3: n. 23, 20%) were observed during follow-up. Incidence rates of complications per 100 patient-years were: 4.5 (haemorrhages, grade ≥ 3: 1.7), 1.7 (thromboses, grade ≥ 3: 0.9), and 3.9 (infections, grade ≥ 3: 0.7). TRAs use were associated with reduced risk of bleeding and infections, while cardiovascular risk factors (particularly, diabetes) significantly predicted thromboses and infections. Conclusions: Age-adapted treatment strategies are required in elderly and very elderly patients.

KW - Elderly

KW - Immune thrombocytopenia

KW - ITP

KW - Toxicity

KW - TPO-receptor agonists

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