Onkológia S3/2022

Treatment options for patients with chronic immune thrombocytopenia

Introduction: Immune thrombocytopenia (ITP) is an autoimmune disease, characterized by isolated thrombocytopenia. In adults with ITP, who are corticosteroid-dependent or have no response to corticosteroids and have ITP for ≥ 3 months, should be treated with TPO-RA. Individual patient preference may place higher value on use of daily oral medication or weekly subcutaneous injection. Case: In the article, we present the casuistry of a patient with chronic ITP, in whom treatment with romiplostim or eltrombopag did not produce the desired effect, i.e. maintaining platelet counts ≥ 30x109/l, and due to intermittent bleeding episodes, we were forced to add short-term corticosteroids or IVIg to treatment several times. Lastly, treatment with avatrombopag was started, but did not produce any significant effect so far. Conclusion: In our experience, most patients respond well to treatment with TPO-RA agonists, but there is a certain percentage of patients in whom we do not achieve disease remission or at least a safe platelet count by any treatment modality. Still, in our case there is the possibility of administration of rituximab or splenectomy or other immunosuppressive drugs.

Keywords: thrombocytopenia, autoimmune disease, corticosteroids, TPO agonists