Management of elderly patients with immune thrombocytopenia: Real-world evidence from 451 patients older than 60 years.

ABSTRACT

INTRODUCTION: Primary Immune thrombocytopenia (ITP) in the elderly is a major clinical challenge which is increasingly frequent due to global ageing population. MATERIALS AND METHODS: To describe baseline ITP features, management, and outcome, a centralized electronic database was established, including data of 451 patients aged ≥60 years that were treated from 2000 onwards and were observed for ≥1 year (total observation of 2704 patient-years). RESULTS: At ITP diagnosis, median age was 71.1 years (age ≥ 75 42.8%); 237 (53.9%) patients presented with haemorrhages (grade ≥ 3 7.5%). First-line therapy included prednisone (82.9%), dexamethasone (14.6%), thrombopoietin-receptor agonists (TRAs, 1.3%), and oral immunosuppressive agents (1.1%). Prednisone starting dose ≥1 mg/kg/d (p = .01) and dexamethasone 40 mg/d (p < .001) were mainly reserved to patients aged 60-74, who were more treated with rituximab (RTX, p = .02) and splenectomy (p = .03) second-line. Overall response rates to first and second-line therapies were 83.8% and 84.5%, respectively, regardless of age and treatment type/dose. A total of 178 haemorrhages in 101 patients (grade ≥ 3 n. 52, 29.2%; intracranial in 6 patients), 49 thromboses in 43 patients (grade ≥ 3 n. 26, 53.1%) and 115 infections in 94 patients (grade ≥ 3 n. 23, 20%) were observed during follow-up. Incidence rates of complications per 100 patient-years were 4.5 (haemorrhages, grade ≥ 3 1.7), 1.7 (thromboses, grade ≥ 3 0.9), and 3.9 (infections, grade ≥ 3 0.7). TRAs use were associated with reduced risk of bleeding and infections, while cardiovascular risk factors (particularly, diabetes) significantly predicted thromboses and infections. CONCLUSIONS: Age-adapted treatment strategies are required in elderly and very elderly patients.