PDSA E-News: December 30, 2014

News from the American Society of Hematology (ASH) Annual Meeting

Each year the annual American Society of Hematology (ASH) meeting attracts thousands of clinicians and scientists, worldwide, to learn about and report on the latest hematology research. This year's meeting, held December 6 to 9 in San Francisco, featured more than 10 hours of presentations and more than 80 pages of abstracts about ITP and related diseases. In this issue of the e-news, we report some trends.

The ASH abstract numbers are shown in parentheses.  You can search on the number and read the complete abstract at: https://ash.confex.com/ash/2014/webprogram/start.html, after you 'agree' with the terms.

Making a Correct Diagnosis

ITP Diagnosis Harder in Patients with Moderate Counts and Low Treatment Response

In this experiment doctors sent records of 20 patients with several different diagnoses to three experienced hematologists to see if they would reach the same conclusions.  The ITP diagnosis matched for those with very low platelets and responded to prednisone or IVIg.  However, the diagnosis often didn't match for people who had moderate platelet counts or who did not respond to those treatments.  (3521)  "Difficulties in Establishing the Cause of Thrombocytopenia Among Ambulatory Patients Referred to Hematology: An Agreement Study."

Bleeding Episodes and Treatments Need to be Tracked

Researchers looked at 67 million adults in insurance databases and found 6,651 adults with primary ITP.  57% of those ITP patients had a bleeding-related episode.  A brain bleed was reported in 1.1%.  The study highlights the need to track both bleeding episodes and treatments to fully assess disease burden and effectiveness of treatments.  (202)  "Rate of Bleeding-Related Episodes (BREs) in Adult Patients with Primary Immune Thrombocytopenic Purpura (ITP):  A Population-Based Retrospective Cohort Study of Administrative Medical Claims Data in the United States (US)."

Learning More about Current ITP Treatments

Screen for Hepatitis B Before Getting Rituxan®

People scheduled to take Rituxan should be screened for hepatitis B before getting the treatment since Rituxan can activate a hepatitis B infection.  At a large hospital, researchers found screening was either not being done or not done well.  They suggest a national program to make sure the screen is done and in a standardized way.  (2595)  "Hepatitis B (HBV) Screening in Patients Receiving Rituximab: A Comprehensive Analysis Including Comparison of Adherence by Oncologists and Non-Oncologists."

Dexamethasone Better than Prednisone in Newly Diagnosed

Researchers found high dose dexamethasone performed better than prednisone in newly diagnosed people with ITP.  The authors suggested that dexamethasone would be a better first line treatment. (1455) "Conventional Oral Prednisone versus High-Dose Dexamethasone for Management of Adult Immune Thrombocytopenia:  A Prospective Randomized Multicenter Clinical Trial."

Understanding More about TPO Treatments

Switching TPOs May Help

While romiplostim (Nplate®) and eltrombopag (Promacta®/Revolade®) are similar drugs they are not completely alike.  Most people who are taking Nplate can switch to Promacta without too many problems.  Some people who have problems with Nplate may have a better response and easier time with Promacta, according to a Spanish study.  In the study of 51 ITP patients, about half switched TPOs because of lack of efficacy.  (2790)  "Use of Eltrombopag after Romiplostim in Primary ITP Patients."

Better Response to TPOs If Patient Doesn't Have Anti-GP1b Antibodies

Now there's another good reason to know your anti-platelet antibody status.  Researchers found ITP patients are more likely to respond to the TPO receptor agonists (Nplate®/Promacta®) if they don't have the anti-GP1b type of anti-platelet antibodies.  This finding was also true for the patient's response to IVIg and steroids.  (4190)  "Response to TPO-Receptor Agonists: Role of Immature Platelet Fraction and Anti-GP1b."

Improving Treatment for Children with ITP

Lower Quality of Life Reported in Younger ITP Kids and Those With More Side Effects

In a survey of children with ITP ages 8 to 18, findings showed those who had the most side effects, were diagnosed for a shorter amount of time, were in the younger age group, and didn't participate in sports had a more impaired quality of life than those in other categories. PDSA was a prime contributor to this survey.  (4843)  "A Pilot Study to Assess Quality of Life in Older Children and Adolescents with Primary Immune Thrombocytopenia."

Eltrombopag® Effective in Raising Platelet Counts in Children with ITP

Children with chronic and persistent ITP were given eltrombopag (Promacta®) or their usual treatment.  The study of 174 patients found that children given eltrombopag had higher platelet counts and a similar number of side effects compared to those receiving placebo.  (1450)  "PETIT and PETIT 2: Treatment with Eltrombopag in 171 Children with Chronic Immune Thrombocytopenia (ITP)."

Splenectomy Findings

Higher Counts After Splenectomy Signal Higher Success Rate

If a patient has a splenectomy and their counts the day after the operation are close to or above 112,000 the chances are better that the splenectomy will be more successful.  (1448)  "The Day 1 Postoperative Platelet Count Predicts Splenectomy Response in Patients with Immune Thrombocytopenia."

Splenectomy Increases Risk of Infection and Cardiovascular Problems

People with ITP who have had a splenectomy had increased risk of infection and more cardiovascular problems (heart attacks and strokes) than people with ITP who did not have a splenectomy.  In this study splenectomy success was 48% after 10 or more years.  (232)   "Long-Term Complications after Splenectomy in Adult Chronic Immune Thrombocytopenia with a Minimum Follow up of 10 Years.  First Results from a Single-Center Case-Control Study of 140 Patients with Primary ITP."


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