Research Article| November 01 2017 Resolution Predictors of Childhood Immune Thrombocytopenia AAP Grand Rounds (2017) 38 (5): 52. https://doi.org/10.1542/gr.38-5-52 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Resolution Predictors of Childhood Immune Thrombocytopenia. AAP Grand Rounds November 2017; 38 (5): 52. https://doi.org/10.1542/gr.38-5-52 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: disease remission, inosine triphosphate, purpura, thrombocytopenic, idiopathic, thrombocytopenia due to immune destruction, immunoglobulins, intravenous, adrenal corticosteroids, glucocorticoids, hemorrhage, mineralocorticoids, platelet count measurement Source: Bennett CM, Neunert C, Grace RF, et al. Predictors of remission in children with newly diagnosed immune thrombocytopenia: data from the Intercontinental Cooperative ITP Study Group Registry II participants. Pediatr Blood Cancer. 2017 August 9 [published online ahead of print]; doi: https://doi.org/10.1002/pbc.26736Google Scholar Investigators from multiple institutions in the United States and Switzerland conducted a prospective multisite cohort study to identify demographic and clinical characteristics associated with remission in children with immune thrombocytopenia (ITP). Children 4 months to 19 years of age with newly diagnosed ITP were enrolled. Information collected at diagnosis included platelet count (only those with initial counts <150 × 109/L were enrolled), initial therapy, sex, age, and bleeding severity (based on a standardized scale). At follow-up visits 12 and 24 months after diagnosis, data on clinical course and platelet counts were obtained. Study children who underwent splenectomy were excluded. The primary outcome was remission at 12 and 24 months, defined as a platelet count of >150 × 109/L in a study participant who had not received any platelet-enhancing pharmacological therapy within 6 months (for the 12-month follow-up) or 12 months (for the 24-month follow-up). Characteristics statistically associated with these outcomes in bivariate analyses were included in logistic regression models to identify factors independently associated with ITP remission. Pharmacological therapies included intravenous immunoglobulin (IVIg) alone, corticosteroids alone, anti-D immunoglobulin, and combination therapy with IVIg and corticosteroids. Of 1,239 eligible patients enrolled, 10 children underwent splenectomy. Follow-up data were collected in 705 participants at the 12-month follow-up and in 383 participants at the 24-month follow-up. Rates of remission were 59% (419 of 705) at 12 months and 55% (211 of 383) at 24 months. Overall, 28% of study patients received no pharmacological treatment, 25% received IVIg alone, 26% received corticosteroids alone, and 13% received IVIg-corticosteroid combination treatment. In bivariate analyses, younger age, more severe bleeding at diagnosis, and pharmacological treatment at diagnosis were all associated with statistically higher rates of remission. In multivariate analyses, children <1 year, >1 to <6 years, and >6 to <10 years all had a significantly higher chance of remission at 12 and 24 months than those >10 years old at diagnosis (odds ratios, 4.7, 3.2, and 1.9, respectively, at 12 months and 7.0, 4.1, and 2.1, respectively, at 24 months). Among infants <1 year old at diagnosis, 74% were in remission at 12 months, and 77% were in remission at 24 months. Treatment with IVIg-corticosteroid combination therapy was also associated with significantly higher chances of remission than no treatment at 12 and 24 months; the other treatments were not statistically associated with remission. More severe bleeding at diagnosis was associated with a significantly higher chance of remission at the 12-month follow-up but not at 24 months. The authors conclude that younger age at diagnosis and initial treatment with IVIG-corticosteroid combination therapy are associated with remission in children with ITP. Dr Hogan has disclosed no financial relationship relevant to this commentary. This commentary... You do not currently have access to this content.