EHA 2023 – Report: General topics and ITP in pregnancy

EHA 2023 – Report: General topics and ITP in pregnancy
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In the 28th European Hematology Association Congress, that took place in Frankfurt last June, interesting abstracts concerning different aspects of immune thrombocytopenia (ITP) were presented.

Here you can find a summary of the abstracts about ITP in pregnancy and others such as quality of life of ITP patients, and the search for factors predictive of response to splenectomy and rilzabrutinib.

For other topics, including the impact of COVID-19 and COVID-19 vaccination on ITP, the management of ITP in specific realities, such as Greece, Norway, Algeria, Tunisia and others see the 2023EHA abstract book.

General topics.

A large Danish population cohort study which enrolled 4.768 patients with newly diagnosed, primary ITP from 1980 to 2016, explored the incidence of solid and hematological cancers, compared to general population controls. Patients with ITP had a higher incidence of both hematological (leukemias and lymphomas) and solid cancers (more frequently upper gastrointestinal) (HR 7.43 and 1.29 respectively). Of note, the difference with the general population diminished over time, and equalized for solid cancers (Mannering N. et al.).

The results of the global I-WISH 2.0 survey, addressed to ITP patients and medical doctors, reported on the emotional burden of the disease and the impact on quality of life in terms of fatigue, concentration issues, financial burden, and treatment adherence (Cooper N et al).

A score predicting response to splenectomy was proposed by Zoletto S et al. that included age at diagnosis, autoimmune comorbidities, and dose of pre-splenectomy corticosteroids. It was tested on 25 patients and confirmed in 39, and it will need further validation.

Kuter D et al. explored baseline TPO levels in patients treated with rilzabrutinib, a BTK inhibitor, in the phase I/II trial: median baseline levels were in accordance with that expected (94 pg/mL), and decreased during treatment, concurrently with the increase of platelet counts. No association was observed between baseline platelet or TPO levels and platelets at week 12 or 24. Interestingly, rilzabrutinib was associated with stable B cell levels.

ITP in pregnancy.

Maternal and fetal outcomes in pregnancies of women with ITP in Italy were reported by Carpenedo M et al. Data of 95 pregnancies were retrospectively collected; in 68% of cases women had a prior diagnosis of ITP, but only one was already on treatment (cyclosporine). 65% were treated with first line during pregnancy, 21% received a second-line treatment and 8% a third line. In most cases, women were treated to reach a safe platelet count for delivery. TPO-mimetics were used in 7 cases. Thrombocytopenia was present in 17% of neonates, without life-threatening bleeding. Reports of TPO-mimetics in pregnancy are constantly increasing and their use in the third trimester seems safe for the mother and the baby, in cases of severe, refractory ITP with no other options (Sayed G et al.).