Immune Thrombocytopenia Purpura in the 21st Century

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ITP in the 21st Century

S. Beardsley

Abstract

Immune (or idiopathic) thrombocytopenic purpura (ITP) is commonly

encountered by the practicing hematologist. Clinical management

decisions have traditionally been guided by individual training and

past experience.

Input from the literature has been more from observational reports

of case series than from scientific results of hypothesis-driven

research. Practice guidelines and several surveys of clinical

hematology practice have highlighted important questions in the

field, and in the past 5 to 10 years both clinical and laboratory

investigations have produced valuable new information.

Thrombopoietin levels are normal or only slightly increased in ITP,

and stimulation of thrombopoiesis appears to be a promising new

therapeutic approach in clinical trials. Chronic, refractory ITP in

children or adults remains a challenge for the hematologist. It is

this group that has the greatest risk of serious bleeding,

particularly among the elderly.

The anti-B–cell monoclonal antibody, anti-CD20, has shown benefit in

phase I/II clinical trials in patients who had failed a number of

previous therapeutic modalities.

The standard for clinical research into therapy for ITP has become

evidence-based medicine, and more prospective, randomized clinical

trials are being completed by multi-institutional study groups.

Full-text article at:

http://www.asheducationbook.org/cgi/content/full/2006/1/402