Report of a ‘consensus’ on the lines of therapy for primary immune thrombocytopenia in adults, promoted by the Italian Gruppo di Studio delle Piastrine

Abstract

Despite the publication in 2009 of a paper on ‘terms and definitions of immune thrombocytopenia’ (ITP), some unresolved issues remain and are reflected by the disagreement in the treatment suggested for primary ITP in adults. Considering that these disagreements could be ascribed to non-shared goals, we generated a ‘consensus’ on some terms, definitions, and assertions useful for classifying the different lines of treatment for primary ITP in adults according to their indications and goals. Agreement on the appropriateness of the single assertions was obtained by consensus for the following indicators: 1. classification of four ‘lines of therapy’; 2. acceptance of the expression ‘sequences of disease’ for the indications of the respective four lines of treatment; 3_I. practicability of splenectomy; 3_Ib. acceptance, with only some exceptions, of a ‘timing for elective splenectomy of 12 months’; and 4_a-d. ‘goals of the four lines of therapy.’ On the basis of the consensus, a classification of four lines of treatment for primary ITP in adults was produced. In our opinion, this classification, whose validity is not influenced by the recently published new guidelines of the American Society of Hematology (ASH) and reviews, could reduce the disagreement that still exists regarding the treatment of the disease.

Keywords:

• Classification
• consensus
• goal
• immune thrombocytopenia
• ITP
• therapy

Acknowledgements

The Authors thank Alessia D’Introno, MD at the Operative Unit of Medicine of Ostuni Hospital, ASL BR, Italy, for her secretarial contribution. No support was received for this work. No individuals other than the authors took part in it.

Author Contributions

LC proposed the study/work and realized it initially with MC and GMP and subsequently with AMR and the members of the panel, represented in alphabetic order by EA, JMD, ME, AH, TK, MPL, SRL, KRM, and JWL. The literature search was made by LC and GMP, while its selection was conducted by the members of the panel and checked by LC and AMR. LC, MC, and GMP planned the study/work. The two co-chairmen (LC and MC) with the help of GMP and AMR prepared the questionnaires for the two rounds that were submitted to the panel, processed the respective replies, and wrote the work, which was reviewed, shared and accepted by all the other authors.

Conflicts of Interest

EA: receipt of several grants from different laboratories (Novartis, BMS, Pfizer, Léo Pharma, Boehringer, Ferring, Chugai, Amgen, and Servier); AH: consultancy (Novartis); MPL: consultancy (CSL, Behring, Amgen, Bayer, Novartis, Shiongi, Kedrion, Sysmex), advisory boards (Amgen, Bayer, Novartis), and research funding (Astra Zeneca, PDSA, Novartis, Rigel); KRM: advisory board (Dova, Sanofi, Rigel); JMD: not provided; all other authors: no conflicts of interest.

Additional information

Funding

No support was received for the work.