Management strategies for newly diagnosed immune thrombocytopenia in Italian AIEOP Centres: do we overtreat? Data from a multicentre, prospective cohort study
The aim of the present study was to assess management strategies for immune thrombocytopenia (ITP) among Italian paediatric haematologists, and to compare these with those of recent international guidelines. Predictors of early remission or disease chronicity were also evaluated. During a period of...
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| creator | Parodi, Emilia Russo, Giovanna Farruggia, Piero Notarangelo, Lucia D Giraudo, Maria T Nardi, Margherita Giona, Fiorina Giordano, Paola Ramenghi, Ugo Barone, Angelica Boscarol, Gianluca Cesaro, Simone Fioredda, Francesca Ladogana, Saverio Licciardello, Maria Rossi, Francesca Rubert, Laura Spinelli, Marco Tucci, Fabio |
| description | The aim of the present study was to assess management strategies for immune thrombocytopenia (ITP) among Italian paediatric haematologists, and to compare these with those of recent international guidelines. Predictors of early remission or disease chronicity were also evaluated.
During a period of 1 year, 205 children (age: 1 month-18 years) with newly diagnosed ITP were prospectively enrolled by 16 centres belonging to the Italian Association of Paediatric Haematology and Oncology (AIEOP). We collected the subjects demographic data, history, clinical symptoms, platelet count and treatment at presentation and at subsequent visits.
Of the 205 patients, 47 (23%) were initially managed with a wait-and-see approach. Compared to these patients, children administered platelet-enhancing therapies were significantly younger (median age: 4.75 vs 7.96 years; p |
| doi_str_mv | 10.2450/2020.0041-20 |
| format | Article |
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During a period of 1 year, 205 children (age: 1 month-18 years) with newly diagnosed ITP were prospectively enrolled by 16 centres belonging to the Italian Association of Paediatric Haematology and Oncology (AIEOP). We collected the subjects demographic data, history, clinical symptoms, platelet count and treatment at presentation and at subsequent visits.
Of the 205 patients, 47 (23%) were initially managed with a wait-and-see approach. Compared to these patients, children administered platelet-enhancing therapies were significantly younger (median age: 4.75 vs 7.96 years; p<0.001) and had lower platelet counts. At the 3-month follow-up, 92/202 patients (46%) had persistent ITP. Recovery within 3 months was predicted by younger median age (5.3 vs 7.8 years; p<0.001), and recent viral infection (p<0.001) . At 1 year, 56 patients had chronic ITP, which was associated with older median age (7.54 vs 5.35 years; p<0.001), and a family history of autoimmunity (p<0.05; relative risk: 1.81; 95% confidence interval: 1.09-2.98). In total, 357 pharmacological treatments were recorded (216 intravenous immunoglobulins, 80 steroids). Response to intravenous immunoglobulins did not have an effect on remission rate at 12 months.
Pediatric hematologists in Italian Centre treat over three-quarters of patients with newly diagnosed ITP, despite recent international guidelines. Almost 80% of patients with mild clinical symptoms received pharmacological treatment at diagnosis, which was significantly associated with younger age. Chronicity at 12 months was not affected by different therapeutic approaches at diagnosis or response to therapy.</description><identifier>ISSN: 1723-2007</identifier><identifier>EISSN: 2385-2070</identifier><identifier>DOI: 10.2450/2020.0041-20</identifier><identifier>PMID: 32931416</identifier><language>eng</language><publisher>Italy: Edizioni SIMTI - SIMTI Servizi Srl</publisher><subject>Adolescent ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Guideline Adherence ; Humans ; Immunoglobulins, Intravenous - administration & dosage ; Immunoglobulins, Intravenous - adverse effects ; Infant ; Italy ; Male ; Others ; Platelet Count ; Practice Guidelines as Topic ; Prospective Studies ; Purpura, Thrombocytopenic, Idiopathic - blood ; Purpura, Thrombocytopenic, Idiopathic - drug therapy</subject><ispartof>Blood transfusion = Trasfusione del sangue, 2020-09, Vol.18 (5), p.396-405</ispartof><rights>SIMTI Servizi Srl 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592159/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592159/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32931416$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Parodi, Emilia</creatorcontrib><creatorcontrib>Russo, Giovanna</creatorcontrib><creatorcontrib>Farruggia, Piero</creatorcontrib><creatorcontrib>Notarangelo, Lucia D</creatorcontrib><creatorcontrib>Giraudo, Maria T</creatorcontrib><creatorcontrib>Nardi, Margherita</creatorcontrib><creatorcontrib>Giona, Fiorina</creatorcontrib><creatorcontrib>Giordano, Paola</creatorcontrib><creatorcontrib>Ramenghi, Ugo</creatorcontrib><creatorcontrib>Barone, Angelica</creatorcontrib><creatorcontrib>Boscarol, Gianluca</creatorcontrib><creatorcontrib>Cesaro, Simone</creatorcontrib><creatorcontrib>Fioredda, Francesca</creatorcontrib><creatorcontrib>Ladogana, Saverio</creatorcontrib><creatorcontrib>Licciardello, Maria</creatorcontrib><creatorcontrib>Rossi, Francesca</creatorcontrib><creatorcontrib>Rubert, Laura</creatorcontrib><creatorcontrib>Spinelli, Marco</creatorcontrib><creatorcontrib>Tucci, Fabio</creatorcontrib><creatorcontrib>“AIEOP-ITP Study Group” (Appendix 1)</creatorcontrib><title>Management strategies for newly diagnosed immune thrombocytopenia in Italian AIEOP Centres: do we overtreat? Data from a multicentre, prospective cohort study</title><title>Blood transfusion = Trasfusione del sangue</title><addtitle>Blood Transfus</addtitle><description>The aim of the present study was to assess management strategies for immune thrombocytopenia (ITP) among Italian paediatric haematologists, and to compare these with those of recent international guidelines. Predictors of early remission or disease chronicity were also evaluated.
During a period of 1 year, 205 children (age: 1 month-18 years) with newly diagnosed ITP were prospectively enrolled by 16 centres belonging to the Italian Association of Paediatric Haematology and Oncology (AIEOP). We collected the subjects demographic data, history, clinical symptoms, platelet count and treatment at presentation and at subsequent visits.
Of the 205 patients, 47 (23%) were initially managed with a wait-and-see approach. Compared to these patients, children administered platelet-enhancing therapies were significantly younger (median age: 4.75 vs 7.96 years; p<0.001) and had lower platelet counts. At the 3-month follow-up, 92/202 patients (46%) had persistent ITP. Recovery within 3 months was predicted by younger median age (5.3 vs 7.8 years; p<0.001), and recent viral infection (p<0.001) . At 1 year, 56 patients had chronic ITP, which was associated with older median age (7.54 vs 5.35 years; p<0.001), and a family history of autoimmunity (p<0.05; relative risk: 1.81; 95% confidence interval: 1.09-2.98). In total, 357 pharmacological treatments were recorded (216 intravenous immunoglobulins, 80 steroids). Response to intravenous immunoglobulins did not have an effect on remission rate at 12 months.
Pediatric hematologists in Italian Centre treat over three-quarters of patients with newly diagnosed ITP, despite recent international guidelines. Almost 80% of patients with mild clinical symptoms received pharmacological treatment at diagnosis, which was significantly associated with younger age. Chronicity at 12 months was not affected by different therapeutic approaches at diagnosis or response to therapy.</description><subject>Adolescent</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Guideline Adherence</subject><subject>Humans</subject><subject>Immunoglobulins, Intravenous - administration & dosage</subject><subject>Immunoglobulins, Intravenous - adverse effects</subject><subject>Infant</subject><subject>Italy</subject><subject>Male</subject><subject>Others</subject><subject>Platelet Count</subject><subject>Practice Guidelines as Topic</subject><subject>Prospective Studies</subject><subject>Purpura, Thrombocytopenic, Idiopathic - blood</subject><subject>Purpura, Thrombocytopenic, Idiopathic - drug therapy</subject><issn>1723-2007</issn><issn>2385-2070</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkM1O6zAQhS0EgvKzY301D0DBsZs4ZgGqyl8lECxgHU3iSeurxI4ct6gvw7MS4F4EqzmjOefT0TB2nPBTMUn5meCCn3I-ScaCb7GRkHk6KMW32ShRQg6aqz223_d_Oc9kpvNdtieFlskkyUbs7QEdLqglF6GPASMtLPVQ-wCOXpsNGIsL53syYNt25QjiMvi29NUm-o6cRbAO5hEbiw6m8-vHJ5gNsED9ORgPrwR-TWHYMV7CFUaEesgDQrtqoq0-rSfQBd93VEW7Jqj80oePNiuzOWQ7NTY9Hf2bB-zl5vp5dje-f7ydz6b3405kWRyXtUyrOjVVViplhKo1R5IkpBayNLnKc0pFqnQlBqcyZlILgYkyUmuSUmXygF18cbtV2ZL5rIVN0QXbYtgUHm3x--Lsslj4daFSLZJUD4A_PwHfyf-flu92nYSh</recordid><startdate>202009</startdate><enddate>202009</enddate><creator>Parodi, Emilia</creator><creator>Russo, Giovanna</creator><creator>Farruggia, Piero</creator><creator>Notarangelo, Lucia D</creator><creator>Giraudo, Maria T</creator><creator>Nardi, Margherita</creator><creator>Giona, Fiorina</creator><creator>Giordano, Paola</creator><creator>Ramenghi, Ugo</creator><creator>Barone, Angelica</creator><creator>Boscarol, Gianluca</creator><creator>Cesaro, Simone</creator><creator>Fioredda, Francesca</creator><creator>Ladogana, Saverio</creator><creator>Licciardello, Maria</creator><creator>Rossi, Francesca</creator><creator>Rubert, Laura</creator><creator>Spinelli, Marco</creator><creator>Tucci, Fabio</creator><general>Edizioni SIMTI - SIMTI Servizi Srl</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>5PM</scope></search><sort><creationdate>202009</creationdate><title>Management strategies for newly diagnosed immune thrombocytopenia in Italian AIEOP Centres: do we overtreat? Data from a multicentre, prospective cohort study</title><author>Parodi, Emilia ; Russo, Giovanna ; Farruggia, Piero ; Notarangelo, Lucia D ; Giraudo, Maria T ; Nardi, Margherita ; Giona, Fiorina ; Giordano, Paola ; Ramenghi, Ugo ; Barone, Angelica ; Boscarol, Gianluca ; Cesaro, Simone ; Fioredda, Francesca ; Ladogana, Saverio ; Licciardello, Maria ; Rossi, Francesca ; Rubert, Laura ; Spinelli, Marco ; Tucci, Fabio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p266t-bf35cf5dc6b77d27f90ae3e23923bd8788e52579c2bf37dd4f22a17d399e33763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Guideline Adherence</topic><topic>Humans</topic><topic>Immunoglobulins, Intravenous - administration & dosage</topic><topic>Immunoglobulins, Intravenous - adverse effects</topic><topic>Infant</topic><topic>Italy</topic><topic>Male</topic><topic>Others</topic><topic>Platelet Count</topic><topic>Practice Guidelines as Topic</topic><topic>Prospective Studies</topic><topic>Purpura, Thrombocytopenic, Idiopathic - blood</topic><topic>Purpura, Thrombocytopenic, Idiopathic - drug therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Parodi, Emilia</creatorcontrib><creatorcontrib>Russo, Giovanna</creatorcontrib><creatorcontrib>Farruggia, Piero</creatorcontrib><creatorcontrib>Notarangelo, Lucia D</creatorcontrib><creatorcontrib>Giraudo, Maria T</creatorcontrib><creatorcontrib>Nardi, Margherita</creatorcontrib><creatorcontrib>Giona, Fiorina</creatorcontrib><creatorcontrib>Giordano, Paola</creatorcontrib><creatorcontrib>Ramenghi, Ugo</creatorcontrib><creatorcontrib>Barone, Angelica</creatorcontrib><creatorcontrib>Boscarol, Gianluca</creatorcontrib><creatorcontrib>Cesaro, Simone</creatorcontrib><creatorcontrib>Fioredda, Francesca</creatorcontrib><creatorcontrib>Ladogana, Saverio</creatorcontrib><creatorcontrib>Licciardello, Maria</creatorcontrib><creatorcontrib>Rossi, Francesca</creatorcontrib><creatorcontrib>Rubert, Laura</creatorcontrib><creatorcontrib>Spinelli, Marco</creatorcontrib><creatorcontrib>Tucci, Fabio</creatorcontrib><creatorcontrib>“AIEOP-ITP Study Group” (Appendix 1)</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Blood transfusion = Trasfusione del sangue</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Parodi, Emilia</au><au>Russo, Giovanna</au><au>Farruggia, Piero</au><au>Notarangelo, Lucia D</au><au>Giraudo, Maria T</au><au>Nardi, Margherita</au><au>Giona, Fiorina</au><au>Giordano, Paola</au><au>Ramenghi, Ugo</au><au>Barone, Angelica</au><au>Boscarol, Gianluca</au><au>Cesaro, Simone</au><au>Fioredda, Francesca</au><au>Ladogana, Saverio</au><au>Licciardello, Maria</au><au>Rossi, Francesca</au><au>Rubert, Laura</au><au>Spinelli, Marco</au><au>Tucci, Fabio</au><aucorp>“AIEOP-ITP Study Group” (Appendix 1)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Management strategies for newly diagnosed immune thrombocytopenia in Italian AIEOP Centres: do we overtreat? Data from a multicentre, prospective cohort study</atitle><jtitle>Blood transfusion = Trasfusione del sangue</jtitle><addtitle>Blood Transfus</addtitle><date>2020-09</date><risdate>2020</risdate><volume>18</volume><issue>5</issue><spage>396</spage><epage>405</epage><pages>396-405</pages><issn>1723-2007</issn><eissn>2385-2070</eissn><abstract>The aim of the present study was to assess management strategies for immune thrombocytopenia (ITP) among Italian paediatric haematologists, and to compare these with those of recent international guidelines. Predictors of early remission or disease chronicity were also evaluated.
During a period of 1 year, 205 children (age: 1 month-18 years) with newly diagnosed ITP were prospectively enrolled by 16 centres belonging to the Italian Association of Paediatric Haematology and Oncology (AIEOP). We collected the subjects demographic data, history, clinical symptoms, platelet count and treatment at presentation and at subsequent visits.
Of the 205 patients, 47 (23%) were initially managed with a wait-and-see approach. Compared to these patients, children administered platelet-enhancing therapies were significantly younger (median age: 4.75 vs 7.96 years; p<0.001) and had lower platelet counts. At the 3-month follow-up, 92/202 patients (46%) had persistent ITP. Recovery within 3 months was predicted by younger median age (5.3 vs 7.8 years; p<0.001), and recent viral infection (p<0.001) . At 1 year, 56 patients had chronic ITP, which was associated with older median age (7.54 vs 5.35 years; p<0.001), and a family history of autoimmunity (p<0.05; relative risk: 1.81; 95% confidence interval: 1.09-2.98). In total, 357 pharmacological treatments were recorded (216 intravenous immunoglobulins, 80 steroids). Response to intravenous immunoglobulins did not have an effect on remission rate at 12 months.
Pediatric hematologists in Italian Centre treat over three-quarters of patients with newly diagnosed ITP, despite recent international guidelines. Almost 80% of patients with mild clinical symptoms received pharmacological treatment at diagnosis, which was significantly associated with younger age. Chronicity at 12 months was not affected by different therapeutic approaches at diagnosis or response to therapy.</abstract><cop>Italy</cop><pub>Edizioni SIMTI - SIMTI Servizi Srl</pub><pmid>32931416</pmid><doi>10.2450/2020.0041-20</doi><tpages>10</tpages></addata></record> |
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| ispartof | Blood transfusion = Trasfusione del sangue, 2020-09, Vol.18 (5), p.396-405 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Adolescent Child Child, Preschool Female Follow-Up Studies Guideline Adherence Humans Immunoglobulins, Intravenous - administration & dosage Immunoglobulins, Intravenous - adverse effects Infant Italy Male Others Platelet Count Practice Guidelines as Topic Prospective Studies Purpura, Thrombocytopenic, Idiopathic - blood Purpura, Thrombocytopenic, Idiopathic - drug therapy |
| title | Management strategies for newly diagnosed immune thrombocytopenia in Italian AIEOP Centres: do we overtreat? Data from a multicentre, prospective cohort study |
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