The Warren Alpert Medical School at Brown University, 222 Richmond St, Providence, RI 02903, USA.
Columbia University Irving Medical Center, 3959 Broadway, New York, NY 10032, USA.
Blood Rev. 2021 Sep;49:100822. doi: 10.1016/j.blre.2021.100822. Epub 2021 Mar 8.
Immune thrombocytopenia (ITP), resulting from antibody-mediated platelet destruction combined with impaired platelet production, is a rare cause of thrombocytopenia in both children and adults. The decision to treat newly diagnosed patients is based on several factors, including the desire to increase platelet count to prevent bleeding, induce remission, and improve health-related quality of life (HRQoL). At present, standard first-line therapy is corticosteroids. While this treatment does increase the platelet count in many patients, a high percentage still relapse after discontinuation of therapy. For this reason, alteration or intensification of first-line therapy that results in superior long-term remission rates is desirable. The objective of this review is to outline different upfront strategies for newly diagnosed patients with ITP in an effort to potentially enhance remission rates and prevent relapse, taking into account an assessment of the risks and benefits of each approach. We primarily focus on adults with ITP, highlighting pediatric data and practice when applicable.
免疫性血小板减少症（ITP）是一种罕见的血小板减少症，其发病机制为抗体介导的血小板破坏与血小板生成受损。在儿童和成人中，ITP 均是血小板减少症的罕见病因。新诊断 ITP 患者的治疗决策取决于多个因素，包括提高血小板计数以预防出血、诱导缓解和改善健康相关生活质量（HRQoL）。目前，标准一线治疗为皮质类固醇。虽然该治疗方法可使许多患者的血小板计数升高，但仍有很大比例的患者在停药后复发。出于这个原因，需要改变或强化一线治疗，以提高长期缓解率。本综述的目的是概述新诊断 ITP 患者的不同初始治疗策略，以期潜在提高缓解率并预防复发，同时考虑每种方法的风险和获益。我们主要关注成人 ITP，在适用时强调儿科数据和实践。
