Understanding how older age drives decision-making and outcome in Immune Thrombocytopenia. A single centre study on 465 adult patients

We analysed the impact of older age on the management of immune thrombocytopenia (ITP) in 465 adult patients diagnosed between 1995 and 2017 and followed at our institution for a minimum of 12 months. Over a follow-up of 4248 patient-years, front-line corticosteroids therapy was required in 334 patients (71·8%), mainly (85·3%) within 1 year from diagnosis. Need for first-, second- and third-line therapy was comparable in younger and older (age ≥65 years, n = 154) patients. Older patients presented more frequently with severe haemorrhages, started therapy with a higher platelet count and received lower dose front-line corticosteroids; thereafter, they were preferentially treated with mild immunosuppressive therapies/thrombopoietin-receptor agonists. Conversely, younger patients were more frequently treated with rituximab and splenectomy, achieving higher rates of complete responses. Incidence rates of ≥grade 2 complications were: 2·87 (haemorrhages), 1·55 (infections) and 0·66 (thromboses) per 100 patient-years. Older age (P = 0·01) and active haemorrhages at diagnosis (P = 0·01) significantly predicted grade ≥2 haemorrhages during follow-up. Older age (P = 0·01), male gender (P = 0·01), and thrombopoietin receptor agonist use (P = 0·02) were significantly associated with a higher probability of thrombosis over time. Older age is a significant driver of diagnostic/therapeutic strategy in ITP resulting in different responses and complications rates.