Treatment in idiopathic thrombocytopenic purpura in the elderly: about a retrospective study

There are no specific recommendations on the care of elderly patients with ITP. A retrospective study over two academic centers (Reims and Strasbourg), focused on patients over 65 who have been diagnosed idiopathic thrombocytopenic purpura in two unit of internal medicine. 41 patients were enrolled, including 27 women (66%). The median age is 76.75 years. On admission, the average thrombocytopenia is 34.45 G/L; 24 patients (58.5%) showed severe bleeding mucosal and/or visceral signs; 37 patients (90%) had a first-line treatment. Corticosteroids established for 23 patients (56%). At 1 and 6 months, complete response was 9 patients (39%) and 2 patients (9%) respectively. Adverse events reported for 20 patients (87%). Polyvalent immunoglobulins were used for 6 (16%) with no response at 6 months. 5 patients were treated with danazol. At 6 months, partial response in 3 patients (60%) and failure in 2 patients (40%). Splenectomy was performed for 8 patients (21%). At 1 month, a complete response observed for 7 patients. At 6 months, a failure observed in 4 patients. After failure of first-line treatments, we noted the use of rituximab for 4 patients (9.7%) with a complete response for 1 patient, partial response in 2 patients and a failure for a patient for whom the "eltrombopag" was set up with a partially response. Monitoring of 41 patients, during 7 years, objectified 3 deaths. The clinical presentation of idiopathic thrombocytopenic purpura in the elderly seems more severe. Therapeutic responses are essentially identical to those observed in younger patients, but greater toxicity. Data on biologics is nonexistent in elderly outside small retrospective series. Studies are underway to better assess their effectiveness, long-term safety as well as their mechanism of action.