Comparison of Clinical Features and Treatment Outcomes of Young and Older Adult Patients with Primary İmmune Thrombocytopenia

Year 2022, Volume: 44 Issue: 4, 493 - 498, 19.07.2022

Bilal Aygun Didar Yanardağ Açık

https://doi.org/10.20515/otd.1032816

Abstract

In this study, we aimed to investigate the discrepancies regarding the clinical characteristics and the treatment outcomes between immune thrombocytopenic purpura patients ≤ 60 y and > 60 y, which is the cut-off age for the definition of old age by the WHO. We retrospectively analyzed the data of 67 immune thrombocytopenic purpura patients diagnosed and treated in the Hematology clinic between December 2014 and February 2019. The median age of the patients was 44 years (range, 17-86); 48 (71.6%) patients were female and 19 (28.4%) were male. There were 50 (74.6%) patients aged ≤ 60 y and 17 (25.4%) patients > 60 y. When two groups were compared with respect to treatment features, they were similar in responding to the therapies, the loss of response to therapies and in duration of response to the therapies (p>0.05). When the cutoff point for age was 50 and 65 years again the groups were similar in terms of disease and treatment characteristics (p>0.05). Despite the clinical complexicity and heterogeneity of older adults, the treatment outcomes of olderimmune thrombocytopenic purpura patients seem to be similar to the young ones.

Keywords

ITP, fragility, treatment outcomes, older adults

Primer İmmün Trombositopenili Genç ve Yaşlı Erişkin Hastaların Klinik Özelliklerinin ve Tedavi Sonuçlarının Karşılaştırılması

Abstract

Bu çalışmada, DSÖ'nün yaşlılık tanımı için kesme yaşı olan 60 yaş ve üstü immun trombositopenik purpura hastaları arasında klinik özellikler ve tedavi sonuçları ile ilgili farklılıkları araştırmayı amaçladık. Yöntem: Aralık 2014 ile Şubat 2019 arasında Hematoloji kliniğinde teşhis ve tedavi edilen 67 immun trombositopenik purpura hastasının verilerini geriye dönük olarak analiz ettik. Hastaların ortanca yaşı 44 (aralık, 17-86); hastaların 48'i (%71,6) kadın, 19'u (%28,4) erkekti. ≤ 60 yaşında 50 (%74.6) hasta ve > 60 yaşında 17 (%25.4) hasta vardı. Tedavi özellikleri açısından iki grup karşılaştırıldığında, tedavilere yanıt verme, tedavilere yanıt kaybı ve tedavilere yanıt süresi açısından benzerdi (p>0.05). Yaş için kesme noktası 50 ve 65 olduğunda yine gruplar hastalık ve tedavi özellikleri açısından benzerdi (p>0.05). Yaşlı yetişkinlerin klinik karmaşıklığına ve heterojenliğine rağmen, yaşlı immun trombositopenik purpura hastalarının tedavi sonuçları gençlere benzer görünmektedir.

Keywords

ITP, frajilite, tedavi sonuçları, yaşlı erişkinler

References

• 1. Cines DB, McMillan R. Pathogenesis of chronic immune thrombocytopenic purpura. Curr Opin Hematol 2007;14(5):511-514. doi: 10.1097/MOH.0b013e3282ba5552.
• 2. Stasi R, Evangelista ML, Stipa E, Buccisano F, Venditti A et al. Idiopathic thrombocytopenic purpura: current concepts in pathophysiology and management. Thromb Haemos 2008;99(1):4-13. doi: 10.1160/TH07-08-0513.
• 3. Cines DB, Bussel JB, Liebman HA, Luning Prak ET. The ITP syndrome: pathogenic and clinical diversity. Blood 2009;113(26):6511-6521. doi: 10.1182/blood-2009-01-129155.
• 4. Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr et al. The American Society of Hematology evidence-based practice guideline for immune thrombocytopenia. Blood 2011;117(16):4190-4207. doi: 10.1182/blood-2010-08-302984.
• 5. Cines DB, Bussel JB. How I treat idiopathic thrombocytopenic purpura (ITP). Blood 2005;1;106(7):2244-51. doi: 10.1182/blood-2004-12-4598.
• 6. Cuker A, Neunert CE. How I treat refractory immune thrombocytopenia. Blood 2016;22;128(12):1547-54. doi: 10.1182/blood-2016-03-603365.
• 7. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
• 8. Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen ML et al. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 2014;20;32(24):2595-603. doi: 10.1200/JCO.2013.54.8347.
• 9. McLachlan AJ, Pont LG. Drug metabolism in older people--a key consideration in achieving optimal outcomes with medicines. J Gerontol A Biol Sci Med Sci 2012;67(2):175-80. https://doi: 10.1093/gerona/glr118.
• 10. https://www.who.int/healthinfo/survey/ageingdefnolder/en/
• 11. Buske C, Hutchings M, Ladetto M, Goede V, Mey U et al. ESMO Lymphoma Consensus Conference Panel Members. ESMO Consensus Conference on malignant lymphoma: general perspectives and recommendations for the clinical management of the elderly patient with malignant lymphoma. Ann Oncol 2018;1;29(3):544-562. doi: 10.1093/annonc/mdx413.
• 12. Heraly B, Morrison VA. How I treat chronic lymphocytic leukemia in older patients. J Geriatr Oncol 2015;6(5):333-40. doi: 10.1016/j.jgo.2015.08.003.
• 13. Klepin HD, Rao AV, Pardee TS. Acute myeloid leukemia and myelodysplastic syndromes in older adults. J Clin Oncol 2014;20;32(24):2541-52. doi:10.1200/JCO.2014.55.1564.
• 14. Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D 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;12;113(11):2386-93. doi: 10.1182/blood-2008-07-162503.
• 15. Lucchini E, Fanin R, Cooper N, Zaja F. Management of immune thrombocytopenia in elderly patients. Eur J Intern Med 2018;58:70-76. doi: 10.1016/j.ejim.2018.09.005.
• 16. Martinez MCM, Hurst K, Castellano MEM, Mazo AIH. Primary Immune Thrombocytopenia in Elderly Patients: Clinical Profile, Efficacy and Safety of Treatment Protocols. Blood 2014;124:4196. doi: 10.1182/blood.V124.21.4196.4196.
• 17. Psaila B, Bussel JB. Refractory immune thrombocytopenic purpura: current strategies for investigation and management. Br J Haematol 2008;143(1):16-26. doi: 10.1111/j.1365-2141.2008.07275.x.