Research progress of individual therapies in elderly patients with immune thrombocytopenia

Abstract

Immune thrombocytopenia (ITP) is an autoimmune disorder mediated by both humoral and cellular immunologic abnormalities. Both accelerated destruction of platelets and reduced platelet production participate in the pathogenesis of ITP. It has been previously considered that ITP affects predominantly young or middle-aged women. However, according to recent literatures, the incidence rate increases with age and old patients over the age of 60 become a new population of this disease. Elderly patients with ITP have more complications and worse reaction or tolerance to treatments, and have a higher risk of severe bleeding and increasing mortality than younger patients. The classical therapies of elderly patients with ITP include corticosteroids, intravenous immunoglobulin (IVIG), splenectomy and immune suppression, but still about one-third of the patients can′t receive sustained remission. Recently, with the continuously deepening research, new drugs such as rituximab, thrombopoietin receptor agonist (TPORA) like romiplostim and eltrombopag, mycophenolic mofetil (MMF), etc., have been used in the treatment of elderly patients with ITP, and the results are convincing. Nevertheless, individual treatment according to different pathogenesis becomes more and more important, especially in elderly patients with ITP. In this review, we will discuss the therapies and the latest progress of elderly patients with ITP. Key words: Purpura, thrombocytopenic, idiopathic; Drug therapy; Splenectomy; Aged