Management of Primary Immune Thrombocytopenia, 2012: A Survey of Oklahoma Hematologists-Oncologists

Abstract

BackgroundManagement options for patients with primary immune thrombocytopenia (ITP) have increased, and treatment of patients with ITP has changed during the past 10 years. MethodsTo document current practice and to determine how current practice is related to recommendations of 2 recent practice guidelines for ITP, an international Consensus report and an American society of Hematology (ASH) guideline, the authors surveyed practicing hematologistsoncologists in Oklahoma. Surveys were specific for children or adults. Each survey had 3 questions describing patients with a new diagnosis and patients who had not achieved remission with initial treatment. Questions were adapted from the clinical scenarios of the ASH guideline. ResultsTwelve (92%) Oklahoma pediatric hematologistsoncologists responded; 82 (81%) Oklahoma adult hematologistsoncologists responded. For a child with a new diagnosis of ITP, a platelet count of 8000/μL and minor bleeding, 5 (42%) hematologistsoncologists selected observation without drug treatment (recommended by both guidelines). For an adult with a platelet count of 9000/μL who had failed to respond to initial treatment with corticosteroids and IVIg, 32 (39%) selected splenectomy (recommended by the ASH guideline); 30 (37%) selected rituximab and 13 (16%) selected thrombopoietin-receptor agonists (both recommended by the International Consensus report). Hematologists-oncologists who had more years in practice were more likely to select splenectomy (P = 0.047). ConclusionsIn a time of changing management for patients with ITP, these data document reported current management in Oklahoma and provide a basis for serial comparisons across time and for comparisons with other regions and comparison of management with patient outcomes.