What are the International Consensus Report guidelines for the treatment of immune thrombocytopenia (ITP) after multiple treatment failures?

Updated: Jan 11, 2020
  • Author: Craig M Kessler, MD, MACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Approach when multiple treatments have failed:

  1. Reconsider the diagnosis
  2. Perform bone marrow examination if not already done
  3. Reassess the need for treatment (consider platelet count/bleeding risk)
  4. Consider referral to an ITP treatment center
  5. Reassess the adequacy of prior therapies (eg, was the full dose of TPO-RA explored? Did the addition of a small dose of corticosteroid improve response?)
  6. Assess the risks and benefits of further treatment
  7. Reassess the possibility of splenectomy if not already performed
  8. Consider other medical therapies if not already attempted (eg, MMF, fostamatinib, rituximab, azathioprine, dapsone, danazol)
  9. Consider enrollment in a clinical trial
  10. In patients who relapse >1 year after responding to splenectomy, an accessory spleen should be searched for and, if found, resected.
  11. Switching from one TPO-RA to another and sequential therapy have been shown to have a positive effect on response and adverse effects.
  12. Other therapies that have been used as last resorts include combination chemotherapy, alemtuzumab, and hematopoietic stem cell transplantation (HSCT). The side effects of these treatment options may be severe, and the data supporting their use are limited.

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