Key result
Mixed lymphoid infiltrate linked to ~324% greater relapse risk in ITP patients on TPO analogs.
Why the study?
Do bone marrow characteristics predict outcome in primary immune thrombocytopenia patients treated with thrombopoietin analogs?
Cohort (n=86)
Yes
Do bone marrow characteristics predict outcome in primary immune thrombocytopenia patients treated with thrombopoietin analogs?
Hazard Ratio: 4.24 (95% CI 1.38–13)
Bone marrow characteristics may serve as predictors of outcome in patients with primary immune thrombocytopenia treated with thrombopoietin analogs.
Bone marrow infiltrate may risk-stratify ITP on TPO analogs; hypothesis-generating and should not yet change practice.
It is well established that immune thrombocytopenia (ITP) results from increased immune mediated platelet destruction (anti-platelets antibodies, autoreactive T cells, and reduction of regulatory T cells) along with impaired production in the bone marrow.1 The latter has been attributed to both cellular and humoral mediators that cause suppression of megakaryocyte production and maturation.2 Current standard first line therapy consists of corticosteroids, with or without intravenous Ig, achieving about 70-80% response rate. However, a consistent proportion of patients would relapse after corticosteroid discontinuation or tapering, and requires further therapy. ...
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Fattizzo et al. (2019) conducted a cohort in Primary immune thrombocytopenia (ITP) (n=86). Mixed lymphoid infiltrate in bone marrow vs. No or B-cell infiltrate was evaluated on Relapse-free survival (HR 4.24, 95% CI 1.38-13). In patients with primary immune thrombocytopenia treated with thrombopoietin analogs, the presence of a mixed lymphoid infiltrate in the bone marrow was associated with significantly shorter relapse-free survival (HR 4.24) compared to no or B-cell infiltrate.
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