Vol 3, No 2 (2012)
Case report
Published online: 2012-06-25

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Durable primary immune thrombocytopenia remission after transient romiplostim treatment

Elżbieta Patkowska, Ewa Lech-Marańda, Krzysztof Warzocha
Hematologia 2012;3(2):186-191.

Abstract

Primary immune thrombocytopenia (ITP) is an autoimmune disorder characterised by
a heterogeneous clinical course consisting of remissions and relapses. Recent studies suggest
that the thrombocytopenia observed in ITP is caused by complex immunologic processes as well
as by decreased platelet production (PLT). Thus, new therapeutic approaches now comprise of
thrombopoietin receptor (TPO-R) agonists, (romiplostim and eltrombopag), which stimulate
platelet production. Indeed, their effectiveness has been proven in randomised trials where
during this treatment it is also possible to reduce or even discontinue other ongoing ITP
therapies. It is however necessary that treatment with TPO-R agonists be continuous to
maintain sustained responses and moreover there is a low chance of attaining a durable cure.
A case report is presented of a 69-year-old man diagnosed with ITP in 2005 where, after
initial treatment with corticosteroids, the PLT count remained unchanged and adverse effects
occurred. Second-line therapy with vinca alkaloids and danazol was then introduced resulting
in only a transient improvement in PLT count. Following a further PLT count decrease to
Grade 4, (World Health Organisation classification), a splenectomy was therefore performed
after intravenous immunoglobulins administration; a 2.5-year remission was thereby achieved.
Nevertheless an ITP relapse was subsequently observed and the patient was then assigned to
a clinical trial with romiplostim administration lasting 17 months. The Grade 4 PLT count
decrease however returned when the romiplostim was stopped and the patient was given three
infusions of vincristine without any improvement in PLT count. Despite seeing a temporary
PLT increase following a three time re-implementation of romiplostim the count once again
dropped to previous levels after 6 weeks after which a further two injections of romiplostim
were administered to the patient. As a result, remission from ITP has now been observed for
the last 12 months.

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Hematology in Clinical Practice