A megakaryocyte morphological classification-based predictive model for steroid sensitivity in primary immune thrombocytopenia

Abstract

The first-line therapy for primary immune thrombocytopenia (ITP) is steroids, but about one-third of patients do not respond to steroids. Recent studies have shown megakaryocyte (MK) growth and development abnormalities and poorly compensated thrombopoiesis. Here, we attempted to determine the impact of MK morphological classification on steroid response. We enrolled 170 adult patients with primary ITP and divided them into steroid-sensitive ITP (109/170) and non-steroid-sensitive ITP (61/170) groups. In the univariate logistic model, female, reduced thrombocytogenic MK count (TMC), increased granular MK count to total MK count ratio (GMC/TM ratio), and elevated naked nucleus MK count to TM count ratio were significantly associated with steroid-sensitive ITP. In the multivariate logistic model, sex, reduced TMC, and increased GMC/TM ratio were independent predictors of steroid-sensitive ITP diagnosis. Based on the regression parameters, we established a predictive index with weighted risk score of 1 assigned each to sex, TMC, and GMC/TM ratio. A predictive index ≥2 points had the best area under the curve value (0.63) with 47.7% sensitivity and 78.7% specificity for predicting steroid sensitivity. These findings may help guide early treatment strategies in ITP.

Keywords:

• Megakaryocytes
• megakaryocytic morphology
• predictive model
• primary immune thrombocytopenia
• steroid sensitivity

Author Contributions

Jingjing Zhu and Lixia Zhu: conception and design of the study, protocol development, analysis and interpretation of data, drafting the article; Rongrong Chen and Xueying Li: screening patients, collection of data, analysis, and interpretation of data; Shuqi Zhao: providing the marrow morphological images of sub-classifications of MK. Mixue Xie and Xiujin Ye: conception and design of the study, protocol development, revision of the article.

Conflicts of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

The research was supported by grants from Medical Health Science and Technology Project of Zhejiang Provincial Health Commission [No.2017KY059].