Emilia Parodi1, Giovanna Russo2, Piero Farruggia3, Lucia D Notarangelo4, Maria T Giraudo5, Margherita Nardi6, Fiorina Giona7, Paola Giordano8, Ugo Ramenghi1, Angelica Barone9, Gianluca Boscarol10, Simone Cesaro11, Francesca Fioredda12, Saverio Ladogana13, Maria Licciardello14, Francesca Rossi15, Laura Rubert16, Marco Spinelli17, Fabio Tucci18. 1. Haematology Unit, Department of Paediatric and Public Health Sciences, University of Turin, Turin, Italy. 2. Paediatric Haematology and Oncology Unit, "Policlinico-Vittorio Emanuele" Hospital, University of Catania, Catania, Italy. 3. Paediatric Haematology and Oncology Unit, A.R.N.A.S. Civic Hospital, Palermo, Italy. 4. Onco-Haematology and Bone Marrow Transplantation Unit, Children's Hospital, Brescia, Italy. 5. Department of Mathematics, University of Turin, Turin, Italy. 6. Paediatric Haematology Oncology, Bone Marrow Transplant, "S. Chiara" University Hospital, Pisa, Italy. 7. Department of Translational and Precision Medicine, "Sapienza" University, Rome, Italy. 8. Department of Biomedical Sciences and Human Oncology, Pediatric Section, "A. Moro" University of Bari, Bari, Italy. 9. Department of Paediatric Onco-Haematology, University Hospital, Parma, Italy. 10. Department of Paediatrics, Central Teaching Hospital Bolzano, Bolzano, Italy. 11. Paediatric Haematology Oncology, University Hospital, Verona, Italy. 12. Clinical and Experimental Unit, "G. Gaslini" Children's Hospital, Genoa, Italy. 13. Department of Haematology, "IRCCS Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy. 14. Paediatric Haematology and Oncology Unit, "Vittorio Emanuele" Polyclinic, University of Catania, Italy. 15. "Santobono Pausilipon" Hospital, Naples, Italy. 16. Paediatric Haematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. 17. MBBM Foundation, Department of Paediatrics, University of Milano-Bicocca, Monza, Italy. 18. Department of PaediatricOnco-Haematology, Meyer Children's Hospital, Florence, Italy.
Abstract
BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: 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. DISCUSSION: 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.
BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: 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. DISCUSSION: 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.
Authors: Francesco Rodeghiero; Roberto Stasi; Terry Gernsheimer; Marc Michel; Drew Provan; Donald M Arnold; James B Bussel; Douglas B Cines; Beng H Chong; Nichola Cooper; Bertrand Godeau; Klaus Lechner; Maria Gabriella Mazzucconi; Robert McMillan; Miguel A Sanz; Paul Imbach; Victor Blanchette; Thomas Kühne; Marco Ruggeri; James N George Journal: Blood Date: 2008-11-12 Impact factor: 22.113
Authors: Katja M J Heitink-Pollé; Cuno S P M Uiterwaal; Leendert Porcelijn; Rienk Y J Tamminga; Frans J Smiers; Nicole L van Woerden; Judit Wesseling; Gestur Vidarsson; Annemieke G Laarhoven; Masja de Haas; Marrie C A Bruin Journal: Blood Date: 2018-06-26 Impact factor: 22.113
Authors: D De Mattia; D Del Principe; G C Del Vecchio; M Jankovic; A Arrighini; P Giordano; A Menichelli; P Mori; M Zecca; A Pession Journal: Haematologica Date: 2000-04 Impact factor: 9.941