What are the ASH recommendations for treatment of immune thrombocytopenia (ITP) in adults?

Updated: Jan 11, 2020
  • Author: Craig M Kessler, MD, MACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

The 2019 ASH guidelines recommend against treatment of patients with a platelet count ≥30×109/L. For newly diagnosed adult patients with a platelet count < 30×109/L, the guidelines suggest treatment with corticosterioids. For adults with a platelet count < 20×109/L who are asymptomatic or have minor mucocutaneous bleeding, the guidelines suggest hospital admission for newly diagnosed patients but outpatient treatment for those with an established diagnosis of ITP.  [8]

For first-line treatment, the guidelines recommend a short course (≤6 weeks) of steroids over a prolonged course (> 6 weeks, including treatment and taper). Additional first-line treatment suggestions include the following [8] :

  • Either prednisone (0.5-2.0 mg/kg per day) or dexamethasone (40 mg per day for 4 days) as the type of corticosteroid 
  • Corticosteroids alone rather than rituximab and corticosteroids

The following 2011 ASH treatment suggestions remain unchanged [42] :

  • IVIG may be used with corticosteroids when a more rapid increase in platelet count is required
  • Either IVIG or anti-D (in appropriate patients) may be used if corticosteroids are contraindicated
  • If used, IVIG should be administered in a single dose of 1 g/kg; the dose may be repeated if necessary

For adults with ITP for ≥3 months who are corticosteroid dependent or unresponsive to corticosteroids, the 2019 second-line treatment suggestions include the following, in order of preference [8] :

  • A TPO-RA (either eltrombopag or romiplostim)
  • Rituximab
  • Splenectomy

The 2011 recommendation that for medically suitable patients, laparoscopic and open splenectomy offer similar efficacy, also remains unchanged. [8]


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