Primary immune thrombocytopenia in very elderly patients: particularities in presentation and management: results from the prospective CARMEN-France Registry.
elderly
epidemiology
idiopathic
immune thrombocytopenia
purpura
thrombocytopenic
Journal
British journal of haematology
ISSN: 1365-2141
Titre abrégé: Br J Haematol
Pays: England
ID NLM: 0372544
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
received:
23
08
2021
accepted:
19
10
2021
pubmed:
6
11
2021
medline:
11
3
2022
entrez:
5
11
2021
Statut:
ppublish
Résumé
Data about the presentation and the management of primary immune thrombocytopenia (ITP) in very elderly patients (VEPs; aged ≥80 years) are lacking. The aim of the present study was to describe ITP in this subgroup. The data source was the prospective CARMEN-France registry. Patients included between 2013 and 2018 were selected. ITP presentation and management in VEPs was compared to elderly patients (EPs; aged 65-79 years). We assessed factors associated with bleeding at ITP onset in VEPs. Of 541 patients, 184 were included: 87 in the VEP group and 97 in the EP group. The mean age was 85·7 years in the VEP group. Comorbidities were more frequent in the VEP group (67·4% vs. 47·9%). The median platelet count at ITP onset was similar but severe bleeding tended to be more frequent in VEPs (10·3% vs. 4·1%, P = 0·1) as well as mortality. Exposure to ITP drugs, response to first-line treatment, need of second-line treatment, evolution towards persistency, occurrence of bleeding, infection and thrombosis did not differ between groups. In VEPs, factors associated to bleeding were female sex [odds ratio (OR) 4·75, 95% confidence interval (CI) 1·31-17·32] and platelet count of <20 × 10
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1262-1270Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 British Society for Haematology and John Wiley & Sons Ltd.
Références
Neunert C, Terrell DR, Arnold DM, Buchanan G, Cines DB, Cooper N, et al. American Society of Hematology 2019 Guidelines for Immune Thrombocytopenia. Blood Adv. 2019;3:38.
Audia S, Mahévas M, Samson M, Godeau B, Bonnotte B. Pathogenesis of immune thrombocytopenia. Autoimmun Rev. 2017;16:620-32.
Moulis G, Palmaro A, Montastruc JL, Godeau B, Lapeyre-Mestre M, Sailler L, et al. Epidemiology of incident immune thrombocytopenia: a nationwide population-based study in France. Blood. 2014;124:3308-15.
Segal JB, Powe NR. Prevalence of immune thrombocytopenia: analyses of administrative data. J Thromb Haemost. 2006;4:2377-83.
Bennett D, Hodgson ME, Shukla A, Logie JW. Prevalence of diagnosed adult immune thrombocytopenia in the United Kingdom. Adv Ther. 2011;28:1096-104.
Marieke Schoonen W, Kucera G, Coalson J, Li L, Rutstein M, Mowat F, et al. Epidemiology of immune thrombocytopenic purpura in the General Practice Research Database. Br J Haematol. 2009;145:235-44.
Frederiksen H, Schmidt K. The incidence of idiopathic thrombocytopenic purpura in adults increases with age. Blood. 1999;94:909-13.
Moulis G, Germain J, Comont T, Brun N, Dingremont C, Castel B, et al. Newly diagnosed immune thrombocytopenia adults: clinical epidemiology, exposure to treatments, and evolution. Results of the CARMEN multicenter prospective cohort. Am J Hematol. 2017;92:493-500.
Piel-Julian ML, Mahévas M, Germain J, Languille L, Comont T, Lapeyre-Mestre M, et al. Risk factors for bleeding, including platelet count threshold, in newly diagnosed immune thrombocytopenia adults. J Thromb Haemost. 2018;16:1830-42.
Vianelli N, Valdrè L, Fiacchini M, De Vivo A, Gugliotta L, Catani L, et al. Long-term follow-up of idiopathic thrombocytopenic purpura in 310 patients. Haematologica. 2001;86:504-9.
Bizzoni L, Mazzucconi MG, Gentile M, Santoro C, Bernasconi S, Chiarotti F, et al. Idiopathic thrombocytopenic purpura (ITP) in the elderly: clinical course in 178 patients. Eur J Haematol. 2006;76:210-6.
Guthrie TH, Brannan DP, Prisant LM. Idiopathic thrombocytopenic purpura in the older adult patient. Am J Med Sci. 1988;296:17-21.
Cortelazzo S, Finazzi G, Buelli M, Molteni A, Viero P, Barbui T, et al. High risk of severe bleeding in aged patients with chronic idiopathic thrombocytopenic purpura. Blood. 1991;77:31-3.
Cohen YC, Djulbegovic B, Shamai-Lubovitz O, Mozes B. The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts. Arch Intern Med. 2000;160:1630-8.
Daou S, Federici L, Zimmer J, Maloisel F, Serraj K, Andrès E. Idiopathic thrombocytopenic purpura in elderly patients: a study of 47 cases from a single reference center. Eur J Intern Med. 2008;19:447-51.
Zhou H, Fu R, Wang H, Zhou F, Li H, Zhou Z, et al. Immune thrombocytopenia in the elderly: clinical course in 525 patients from a single center in China. Ann Hematol. 2013;92:79-87.
Michel M, Rauzy OB, Thoraval FR, Languille L, Khellaf M, Bierling P, et al. Characteristics and outcome of immune thrombocytopenia in elderly: results from a single center case-controlled study. Am J Hematol. 2011;86:980-4.
Palandri F, Catani L, Auteri G, Bartoletti D, Fatica S, Fusco A, et al. Understanding how older age drives decision-making and outcome in Immune Thrombocytopenia. A single centre study on 465 adult patients. Br J Haematol. 2019;184:424-30.
Pontikoglou C, Kaliafentaki V, Stavroulaki E, Tzikoulis V, Kanellou P, Symeonidis A, et al. Primary immune thrombocytopenia (ITP) in the elderly and younger adults: real-world comparative retrospective study from the ITP registry of the Hellenic Society of Hematology. EHA Library 2019;266492;PF693.
Palandri F, Santoro C, Carpenedo M, Cantoni S, Barcellini W, Carli G, et al. Management of elderly patients with immune thrombocytopenia: real-world evidence from 451 patients older than 60 years. Thromb Res. 2020;185:88-95.
Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009;113:2386-93.
Latouche A, Allignol A, Beyersmann J, Labopin M, Fine JP. A competing risks analysis should report results on all cause-specific hazards and cumulative incidence functions. J Clin Epidemiol. 2013;66:648-53.
Provan D, Arnold DM, Bussel JB, Chong BH, Cooper N, Gernsheimer T, et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv. 2019;3:3780-817.
Moulis G, Lapeyre-Mestre M, Montastruc JL, Sailler L. Exposure to non-corticosteroid treatments in adult primary immune thrombocytopenia before the chronic phase in the era of thrombopoietin receptor agonists in France. A Nationwide population-based Study. Autoimmun Rev. 2015;14:168-73.
Khellaf M, Charles-Nelson A, Fain O, Terriou L, Viallard JF, Cheze S, et al. Safety and efficacy of rituximab in adult immune thrombocytopenia: results from a prospective registry including 248 patients. Blood. 2014;124:3228-36.
Zaja F, Vianelli N, Volpetti S, Battista ML, Defina M, Palmieri S, et al. Low-dose rituximab in adult patients with primary immune thrombocytopenia. Eur J Haematol. 2010;85:329-34.
Marangon M, Vianelli N, Palandri F, Mazzucconi MG, Santoro C, Barcellini W, et al. Rituximab in immune thrombocytopenia: gender, age, and response as predictors of long-term response. Eur J Haematol. 2017;98:371-7.
Palandri F, Rossi E, Bartoletti D, Ferretti A, Ruggeri M, Lucchini E, et al. Real-world use of thrombopoietin receptor agonists in elderly patients with primary immune thrombocytopenia. Blood. 2021;138:571-83.
Moulis G, Comont T, Adoue D. New insights into the epidemiology of immune thrombocytopenia in adult patients: impact for clinical practice [Article in French]. Rev Med Interne. 2021;42:11-5.