Earlier this month, the American Society of Hematology (ASH) published new state-of-the-art guidelines on the treatment of immune thrombocytopenia. The guidelines were published in the journal Blood Advances.1
The 2019 ASH Clinical Practice Guidelines on Immune Thrombocytopenia, developed in partnership with the University of Oklahoma Health Sciences Center, synthesize all available evidence about existing treatments to offer recommendations for disease management in both children and adults. Notably, these new guidelines address appropriate corticosteroid use in adults and stress avoiding unnecessary treatment in children. They also tackle the complex decision-making surrounding second-line agents. They are intended to help hematologists educate other physicians who provide care to people with immune thrombocytopenia and aid in shared patient-physician decision-making. Where evidence gaps exist, the guidelines make recommendations for future research.
Cindy Neunert, MD
“Through these guidelines, ASH is helping to ensure that physicians and patients have access to all of the evidence available so they can evaluate various treatment options and make an informed decision, using the guideline recommendations as a foundation for care,” said Cindy Neunert, MD, in a statement from ASH. Dr. Neunert is Chair of the ASH immune thrombocytopenia guideline panel and a hematologist at NewYork-Presbyterian Hospital in New York. “The guidelines also equip hematologists, the experts in immune thrombocytopenia, to educate other providers who often see these patients first, such as emergency room physicians, pediatricians, or primary care physicians, who are often less familiar with this disease and its treatments,” she added.
New Guidelines Account for Differences in Children and Adults
Immune thrombocytopenia can be diagnosed at any age, but it is most likely to occur in early childhood and late adulthood. The natural course of the disease looks different in children than it does in adults. The 2019 ASH guidelines take these differences into account, continuing to fulfill a long-recognized need for specific guidance for each population from initial immune thrombocytopenia guidelines ASH published in 2011.
In children, the reduction in platelets is often sudden, but platelet levels usually return to normal levels within weeks to months without treatment. The guidelines can help physicians avoid giving interventions and treatments that have little evidence of success and may have side effects that outweigh potential benefits.
Development of immune thrombocytopenia in adulthood is often more gradual and tends to persist. The guidelines offer new recommendations for use of corticosteroids, often a first-line treatment for adults, that will help physicians evaluate when they should be used, which corticosteroid should be given, the duration of use, and how usage should be monitored. Recommendations for second-line treatments are also provided.
“The 2019 ASH Clinical Practice Guidelines on Immune Thrombocytopenia are a trustworthy resource for patient care in that they are the product of a rigorous process that met the highest standards of transparency,” said Dr. Neunert. “Our multidisciplinary guidelines panel included both adult and pediatric clinical experts; methodologists with expertise in immune thrombocytopenia; and two patient representatives, whose perspectives were extremely valuable in helping us to evaluate the impact of various disease management options on quality of life.”
ASH Initiative for Guidelines
These immune thrombocytopenia guidelines are an update from guidelines the Society published in 2011. They are the most recent product of a larger guideline development initiative for ASH, which includes a commitment to the timely update of existing guidelines and the development of new ones on a range of hematologic conditions. In the coming months, resources to aid in the implementation of the guidelines will be added to the ASH website.
About Immune Thrombocytopenia
Immune thrombocytopenia affects about 2.5 in every 100,000 people in the United States, according to the Centers for Disease Control and Prevention. For most, immune thrombocytopenia causes bruising and petechiae. In more severe cases, it can cause more significant bleeding episodes, such as nose bleeds or bleeding in the moist lining of the mouth, gastrointestinal bleeding, or heavy and prolonged menstrual bleeding. Even without severe bleeding, immune thrombocytopenia can still have a significant impact on patients’ quality of life in the form of fatigue, an inability to perform daily activities, and side effects of treatments. ■
Editor’s note: For the guideline text as well as more information and resources to assist in understanding the 2019 ASH Clinical Practice Guidelines on Immune Thrombocytopenia, visit www.hematology.org/ITPguidelines.
DISCLOSURE: All authors were members of the guideline panel or members of the systematic review team or both. For full disclosures of the authors, visit ASHpublications.org.
1. Neunert C, Terrell DR, Arnold DM, et al: American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv 3:3829-3866, 2019.