A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience

Autor:	Çekdemir D; Anadolu Medical Center, Bone Marrow Transplantation Center, Department of Hematology, Kocaeli, Turkey, Güvenç S; Yeni Yüzyıl University Gaziosmanpaşa Hospital, Department of Hematology, İstanbul, Turkey, Özdemirkıran F; İzmir Atatürk Training and Research Hospital, Clinic of Hematology, İzmir, Turkey, Eser A; Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey, Toptaş T; Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey, Özkocaman V; Uludağ University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Bursa, Turkey, Haydaroğlu Şahin H; Gaziantep University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Gaziantep, Turkey, Ermiş Turak E; Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Kayseri, Turkey, Esen R; Van Yüzüncü Yıl University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Van, Turkey, Cömert M; İnönü University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Malatya, Turkey, Sadri S; İstanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey, Aslaner M; Bülent Ecevit University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Zonguldak, Turkey, Uncu Ulu B; Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Clinic of Hematology, Ankara, Turkey, Karakuş A; Dicle University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Diyarbakır, Turkey, Selim Bapur D; Karadeniz Teknik University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Trabzon, Turkey, Alacacıoğlu İ; Dokuz Eylül University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey, Aydın D; Okmeydanı Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey, Tekinalp A; Namık Kemal University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Tekirdağ, Turkey, Namdaroğlu S; İzmir Bozyaka Training and Research Hospital, Clinic of Hematology, İzmir, Turkey, Ceran F; Ankara Numune Training and Research Hospital, Clinic of Hematology, Ankara, Turkey, Tarkun P; Kocaeli University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Kocaeli, Turkey, Kiper D; Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey, Çetiner M; Koç University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey, Yenerel M; İstanbul University İstanbul Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey, Demir AM; Trakya University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Edirne, Turkey, Yılmaz G; Dr. Lütfi Kırdar Kartal Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey, Terzi H; Cumhuriyet University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Sivas, Turkey, Atilla E; Ankara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey, Malkan ÜY; Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey, Acar K; Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey, Öztürk E; Koç University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey, Tombak A; Mersin University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Mersin, Turkey, Sunu C; Sakarya University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Sakarya, Turkey, Salim O; Akdeniz University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Antalya, Turkey, Alayvaz N; Ondokuz Mayıs University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Samsun, Turkey, Sayan Ö; Medicana Çamlıca Hospital, Clinic of Hematology, İstanbul, Turkey, Ozan Ü; Medical Park Hospital, Clinic of Hematology, Bursa, Turkey, Ayer M; Haseki Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey, Gökgöz Z; Medicana International Ankara Hospital, Clinic of Hematology, Ankara, Turkey, Andıç N; Eskişehir Osmangazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Eskişehir, Turkey, Kızılkılıç E; Acıbadem Kozyatağı Hospital, Clinic of Hematology, İstanbul, Turkey, Noyan F; Başkent University İstanbul Hospital, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey, Özen M; Tokat Gaziosmanpaşa University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Tokat, Turkey, Pepedil Tanrıkulu F; Dr. Ersin Arslan Training and Research Hospital, Clinic of Hematology, Gaziantep, Turkey, Alanoğlu G; Süleyman Demirel University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Isparta, Turkey, Özkan HA; Yeditepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey, Aslan V; Ümit Hospital, Clinic of Hematology, Eskişehir, Turkey, Çetin G; Bezmialem Vakıf University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey, Akyol Erikçi A; İstanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey, Deveci B; Medstar Antalya Hospital, Clinic of Hematology, Antalya, Turkey, Ersoy Dursun F; Göztepe Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey, Dermenci H; Haydarpaşa Numune Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey, Aytan P; Başkent University Training and Research Hospital, Bone Marrow and Stem Cell Transplantation Center, Department of Hematology, Adana, Turkey, Gündüz M; Atatürk Training and Research Hospital, Clinic of Hematology, Ankara, Turkey, Karakuş V; Muğla Sıtkı Koçman University Training and Research Hospital, Department of Hematology, Muğla, Turkey, Özlü C; Ministry of Health Erzurum Regional Training and Research Hospital, Clinic of Hematology, Erzurum, Turkey, Demircioğlu S; Van Yüzüncü Yıl University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Van, Turkey, Akay Yanar OM; Eskişehir Osmangazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Eskişehir, Turkey, Özatlı D; Ondokuz Mayıs University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Samsun, Turkey, Ündar L; Akdeniz University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Antalya, Turkey, Tiftik EN; Mersin University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Mersin, Turkey, Türköz Sucak AG; Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey, Haznedaroğlu İ; Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey, Özcan M; Ankara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey, Şencan M; Cumhuriyet University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Sivas, Turkey, Tombuloğlu M; Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey, Özet G; Ankara Numune Training and Research Hospital, Clinic of Hematology, Ankara, Turkey, Bilgir O; İzmir Bozyaka Training and Research Hospital, Clinic of Hematology, İzmir, Turkey, Turgut B; Namık Kemal University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Tekirdağ, Turkey, Özcan MA; Dokuz Eylül University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey, Payzın KB; Yeni Yüzyıl University Gaziosmanpaşa Hospital, Department of Hematology, İstanbul, Turkey, Sönmez M; Karadeniz Teknik University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Trabzon, Turkey, Ayyıldız O; Dicle University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Diyarbakır, Turkey, Dal MS; Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Clinic of Hematology, Ankara, Turkey, Ertop Ş; Bülent Ecevit University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Zonguldak, Turkey, Turgut M; Ondokuz Mayıs University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Samsun, Turkey, Soysal T; İstanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey, Kaya E; İnönü University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Malatya, Turkey, Ünal A; Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Kayseri, Turkey, Pehlivan M; Gaziantep University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Gaziantep, Turkey, Atagündüz I; Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey, Tuğlular Fıratlı T; Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey, Saydam G; Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey, Diz Küçükkaya R; İstanbul University Science Faculty, Department of Molecular Biology and Genetics, İstanbul, Turkey
Jazyk:	angličtina
Zdroj:	Turkish journal of haematology : official journal of Turkish Society of Haematology [Turk J Haematol] 2019 Nov 18; Vol. 36 (4), pp. 230-237. Date of Electronic Publication: 2019 Jul 22.
DOI:	10.4274/tjh.galenos.2019.2018.0307
Abstrakt:	Objective: The aim of the present study was to evaluate the efficacy and safety of eltrombopag, an oral thrombopoietin receptor agonist, in patients with chronic immune thrombocytopenia (ITP). Materials and Methods: A total of 285 chronic ITP patients (187 women, 65.6%; 98 men, 34.4%) followed in 55 centers were enrolled in this retrospective cohort. Response to treatment was assessed according to platelet count (/mm 3 ) and defined as complete (platelet count of >100,000/mm 3 ), partial (30,000-100,000/mm 3 or doubling of platelet count after treatment), or unresponsive (<30,000/mm 3 ). Clinical findings, descriptive features, response to treatment, and side effects were recorded. Correlations between descriptive, clinical, and hematological parameters were analyzed. Results: The median age at diagnosis was 43.9±20.6 (range: 3-95) years and the duration of follow-up was 18.0±6.4 (range: 6-28.2) months. Overall response rate was 86.7% (n=247). Complete and partial responses were observed in 182 (63.8%) and 65 (22.8%) patients, respectively. Thirty-eight patients (13.4%) did not respond to eltrombopag treatment. For patients above 60 years old (n=68), overall response rate was 89.7% (n=61), and for those above 80 years old (n=12), overall response rate was 83% (n=10). Considering thrombocyte count before treatment, eltrombopag significantly increased platelet count at the 1 st , 2 nd , 3 rd , 4 th , and 8 th weeks of treatment. As the time required for partial or complete response increased, response to treatment was significantly reduced. The time to reach the maximum platelet levels after treatment was quite variable (1-202 weeks). Notably, the higher the maximum platelet count after eltrombopag treatment, the more likely that side effects would occur. The most common side effects were headache (21.6%), weakness (13.7%), hepatotoxicity (11.8%), and thrombosis (5.9%). Conclusion: Results of the current study imply that eltrombopag is an effective therapeutic option even in elderly patients with chronic ITP. However, patients must be closely monitored for response and side effects during treatment. Since both response and side effects may be variable throughout the follow-up period, patients should be evaluated dynamically, especially in terms of thrombotic risk factors.
Databáze:	MEDLINE
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