Refractory primary immune thrombocytopenia (ITP): current clinical challenges and therapeutic perspectives
| Autor: | Nicola Vianelli, Giuseppe Auteri, Francesco Buccisano, Valentina Carrai, Erminia Baldacci, Cristina Clissa, Daniela Bartoletti, Gaetano Giuffrida, Domenico Magro, Elena Rivolti, Daniela Esposito, Gian Marco Podda, Francesca Palandri |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Purpura
Thrombocytopenic Idiopathic Settore MED/09 - Medicina Interna Thrombopoietin receptor agonists (TPO-RA) Fc Immune thrombocytopenia (ITP) Refractory ITP Recombinant Fusion Proteins Idiopathic Hematology General Medicine Receptors Fc Thrombocytopenia Thrombocytopenic Real-life clinical practice Thrombopoietin Receptors Splenectomy Humans Combination therapy Rituximab Receptors Thrombopoietin Purpura |
| Zdroj: | Annals of hematology. 101(5) |
| ISSN: | 1432-0584 |
| Popis: | Chronic primary immune thrombocytopenia (ITP) can today benefit from multiple therapeutic approaches with proven clinical efficacy, including rituximab, thrombopoietin receptor agonists (TPO-RA), and splenectomy. However, some ITP patients are unresponsive to multiple lines of therapy with prolonged and severe thrombocytopenia. The diagnosis of refractory ITP is mainly performed by exclusion of other disorders and is based on the clinician's expertise. However, it significantly increases the risk of drug-related toxicity and of bleedings, including life-threatening events. The management of refractory ITP remains a major clinical challenge. Here, we provide an overview of the currently available treatment options, and we discuss the emerging rationale of new therapeutic approaches and their strategic combination. Particularly, combination strategies may target multiple pathogenetic mechanisms and trigger additive or synergistic effects. A series of best practices arising both from published studies and from real-life clinical experience is also included, aiming to optimize the management of refractory ITP. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink