Immune Thrombocytopenia in Very Elderly Patients: Particularities in Presentation and Management. Results from the Multicenter Prospective Carmen-France Registry

Autor: Aurélien Sokal, Thomas de Nadaï, Thibault Comont, Nicolas Limal, Marc Michel, Odile Beyne-Rauzy, Bertrand Godeau, Daniel Adoue, Matthieu Mahévas, Guillaume Moulis, Carmen investigators Group
Rok vydání: 2019
Předmět:
Zdroj: Blood. 134:1091-1091
ISSN: 1528-0020
0006-4971
DOI: 10.1182/blood-2019-126019
Popis: Introduction: The incidence of immune thrombocytopenia (ITP) is high in the elderly. Observational studies demonstrated that age above 65 years impacts ITP presentation and management. However, data are lacking in very elderly patients (VEP) with ITP. The aim of this study was to describe the presentation and the management of primary ITP that occurs in VEP (≥80 year-old) in comparison with elderly patients (EP; ≥65-79 year-old). Methods: Data source was the CARMEN-France registry. The CARMEN (Cytopénies Auto-immunes : Registre Midi-PyréneEN) registry is aimed at the prospective follow-up of all incident ITP adult patients in the French Midi-Pyrénées region (South-West of France, 3 million inhabitants) since June 2013. Each investigator follows all adult patients (aged ≥18 years) newly diagnosed for ITP in routine visit or hospital stay and detailed information on patients' characteristics and management of ITP are prospectively recorded. This registry has been implemented in the French referral center for ITP (Créteil) since October 2015, taking the name of CARMEN-France. Inclusion criteria in the present study were: inclusion in the CARMEN-France registry between June 2013 and December 2018; age ≥65 years at ITP onset; primary ITP defined by international criteria (platelets count Results: Out of 541 patients included in the CARMEN-France registry, 184 fulfilled inclusion criteria: 87 in the VEP group and 97 in the EP group. Mean age was 85.7 years in the VEP group versus 71.8 in the EP group. Male:female sex-ratio was similar (63.2% vs. 60.8%). Patients in the VEP group had more frequently comorbidities of the Charlson's Index (67.4% versus 47.9%) and polypharmacy (≥4 drugs; 63.3% versus 45.4%); they were more frequently exposed to antiplatelet drugs (37.9% versus 23.7%) and to anticoagulant (18.4% versus 10.3%). Median platelet counts at ITP onset were similar (22.0 versus 18.0 x 109/L). The frequencies of any bleeding were similar (58.6% versus 54.6%) as well as mucosal bleeding (25.3% versus 26.8%), but severe bleeding was more frequent in the VEP group (10.3% versus 4.1%). The frequencies of any bleeding and mucosal bleeding were higher in case of platelet count Conclusion: VEP had more frequently severe bleeding at ITP onset. They were more frequently exposed to IVIg but did not require more frequently a second-line treatment. The pattern of second-line treatment was similar between VEP and EP. Platelet count Methods: Data source was the CARMEN-France registry. The CARMEN (Cytopénies Auto-immunes : Registre Midi-PyréneEN) registry is aimed at the prospective follow-up of all incident ITP adult patients in the French Midi-Pyrénées region (South-West of France, 3 million inhabitants) since June 2013. Each investigator follows all adult patients (aged ³18 years) newly diagnosed for ITP in routine visit or hospital stay and detailed information on patients' characteristics and management of ITP are prospectively recorded. This registry has been implemented in the French referral center for ITP (Créteil) since October 2015, taking the name of CARMEN-France. Inclusion criteria in the present study were: inclusion in the CARMEN-France registry between June 2013 and December 2018; age ≥65 years at ITP onset; primary ITP defined by international criteria (platelets count Results: Out of 541 patients included in the CARMEN-France registry, 184 fulfilled inclusion criteria: 87 in the VEP group and 97 in the EP group. Mean age was 85.7 years in the VEP group versus 71.8 in the EP group. Male:female sex-ratio was similar (63.2% vs. 60.8%). Patients in the VEP group had more frequently comorbidities of the Charlson's Index (67.4% versus 47.9%) and polypharmacy (³4 drugs; 63.3% versus 45.4%); they were more frequently exposed to antiplatelet drugs (37.9% versus 23.7%) and to anticoagulant (18.4% versus 10.3%). Median platelet counts at ITP onset were similar (22.0 versus 18.0 x 109/L). The frequencies of any bleeding were similar (58.6% versus 54.6%) as well as mucosal bleeding (25.3% versus 26.8%), but severe bleeding was more frequent in the VEP group (10.3% versus 4.1%). The frequencies of any bleeding and mucosal bleeding were higher in case of platelet count Conclusion: VEP had more frequently severe bleeding at ITP onset. They were more frequently exposed to IVIg but did not require more frequently a second-line treatment. The pattern of second-line treatment was similar between VEP and EP. Platelet count Disclosures Comont: BMS: Consultancy, Membership on an entity's Board of Directors or advisory committees. Michel:Rigel: Consultancy; Amgen: Consultancy; Novartis: Consultancy. Beyne-Rauzy:Cellgene: Research Funding; Novartis: Research Funding. Godeau:Amgen: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau. Moulis:Amgen pharma: Research Funding, Speakers Bureau; Novartis pharma: Research Funding, Speakers Bureau; CSL Behring: Research Funding.
Databáze: OpenAIRE
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