Table of Contents
ITP – an update
Historic Background
Annual incidence of ITP (plt < 50 x 109/L) in adult population
Overall ITP-related mortality
Adult ITP-related mortality in refractory patients
Questions that still require answers
Critical decisional steps in ITP*
First case – slide 1
What are the initial options?
Guidelines for the management of ITP – Initial treatment
Short and long term response in terms of platelet count to first line treatments
PPT Slide
First case – slide 2
What should we do next ?
Which therapy at this point? Pros and cons
The course of severe ITP in patients failing first line therapy and not undergoing splenectomy A sub-group analysis from Sailer et al, Haematologica, 2006
Comparison of 50µg/kg vs. 75µg/kg
IV anti-D Therapy:Use in Maintenance
Long Term Follow Up Median 26 (range 6 to 54) mos
Guidelines for the management of ITP Splenectomy
Short and long term response in terms of platelet count to splenectomy (Kojoury et al, Blood 2004)
Hazards of Splenectomy
First case – slide 3
Second case – slide 1
What are the potential choices?
Alternatives to splenectomy
Second case – slide 2
Third case – slide 1
What is the appropriate choice?
Is there a more lasting response to high dose Dexamethasone?
Guidelines for the management of refractory ITP: indication for treatment
Guidelines for the management of refractory ITP: which agent?
New drugs for chronic refractory ITP ?
Rituximab Is an Alternative to Splenectomy in Adults With Chronic ITP: Phase II Study
Anti CD 20 (Rituximab) in ITP (375 mg/m2 per week i.v. for 4 consecutive weeks)
Duration of Response to Rituximab in Patients with Chronic ITP with Response Duration > 1 year
Limitations of anti CD 20 ab treatment
Impact of new treatments on the traditional management of ITP
2nd Generation Thrombopoietic Growth Factors
PPT Slide
AMG 531 - Long-Term Open-Label Extension Study Mean Platelet Counts and Mean Dose (N=34)
Summary of 10 year response to treatment in severe ITP
Lessons from series of treated ITP
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