Therapies for relapsed or resistant ITP
| Therapy . | Response rate . | Time to response . | Toxicity . | Duration of response . |
|---|---|---|---|---|
| Splenectomy | 80% overall, | 1-24 d | Surgical complications | Approximately 2/3 of patients will require no further therapy |
| 66% stable | Infection (2-3 times baseline risk) | |||
| Thrombosis (∼2 times baseline risk) | ||||
| Rituximab | 60% overall, | 1-8 wk | Hypersensitivity reactions | 20-25% sustained at 5 y, although patients may be retreated |
| 40% stable | Immune suppression | |||
| Hepatitis B reactivation | ||||
| TPO mimetics (eg, romiplostim, eltrombopag) | >80% overall, | 2-3 wk | Rebound thrombocytopenia | Continuous as long as drug is administered |
| 40-50% stable | Thrombosis | In patients who have an initial response, >90% maintain that response at 5 y | ||
| Hepatotoxicity (eltrombopag) | ||||
| Increased marrow reticulin deposition (1.8-7%) | ||||
| Syk inhibitor (fostamatinib) | 43% overall, | 2-8 wk | Diarrhea, nausea | Unknown, but assumed to be continuous as long as drug is administered |
| 18% stable | Hypertension | |||
| Neutropenia |
| Therapy . | Response rate . | Time to response . | Toxicity . | Duration of response . |
|---|---|---|---|---|
| Splenectomy | 80% overall, | 1-24 d | Surgical complications | Approximately 2/3 of patients will require no further therapy |
| 66% stable | Infection (2-3 times baseline risk) | |||
| Thrombosis (∼2 times baseline risk) | ||||
| Rituximab | 60% overall, | 1-8 wk | Hypersensitivity reactions | 20-25% sustained at 5 y, although patients may be retreated |
| 40% stable | Immune suppression | |||
| Hepatitis B reactivation | ||||
| TPO mimetics (eg, romiplostim, eltrombopag) | >80% overall, | 2-3 wk | Rebound thrombocytopenia | Continuous as long as drug is administered |
| 40-50% stable | Thrombosis | In patients who have an initial response, >90% maintain that response at 5 y | ||
| Hepatotoxicity (eltrombopag) | ||||
| Increased marrow reticulin deposition (1.8-7%) | ||||
| Syk inhibitor (fostamatinib) | 43% overall, | 2-8 wk | Diarrhea, nausea | Unknown, but assumed to be continuous as long as drug is administered |
| 18% stable | Hypertension | |||
| Neutropenia |