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Pontikoglou, C.1; Kaliafentaki, V.1; Stavroulaki, E.2; Tzikoulis, V.1; Kanellou, P.2; Symeonidis, A.3; Patrinos, A.3; Kourakli, A.3; Chatzilygeroudi, T.3; Panayiotidis, P.4; Viniou, N.-A.5; Matzourani, M.5; Dimou, M.4; Galanopoulos, A.6; Chondropoulos, S.6; Roubakis, C.6; Liapi, D.2; Kolovou, A.7; Tsirakis, G.7; Anagnostopoulos, A.8; Syrigou, A.8; Gavriilaki, E.8; Megalakaki, A.9; Lampropoulou, P.9; Vlachaki, E.10; Christodoulou, I.10; Papaioannou, M.11; Gogou, V.11; Bobola, M.12; Giannouli, S.13; Kotsianidis, I.14; Vassilopoulos, G.15; Protopappa, M.16; Hatzimichael, E.17; Zikos, P.18; Chalkiadakis, G.19; Papadaki, H. A.1

doi: 10.1097/01.HS9.0000561056.76786.63
Poster Session I: Platelets disorders

1Department of Hematology, University of Crete School of Medicine

2Department of Hematology, Venizeleio-Pananeio General Hospital, Heraklion, Crete

3Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras

4First Propedeutic Department of Internal Medicine

5First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University, Athens

6Clinical Hematology, G.Gennimatas District General Hospital, Athens

7Chania General Hospital “St. George”, Chania

8Hematology Department-BMT Unit, George Papanikolaou Hospital, Thessaloniki

9Department of Hematology, Metaxa Anticancer Hospital, Piraeus

10Second Department of Internal Medicine, Aristotle University of Thessaloniki Hippokration General Hospital

11First Internal Medicine Department, Aristotle University of Thessaloniki AHEPA University Hospital, Thessaloniki

12Department of Hematology-Blood donation, Pamakaristos General Hospital

13Second Department of Internal Medicine, National and Kapodistrian University of Athens, Athens

14Department of Hematology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis

15Department of Hematology, Faculty of Medicine School of Health Sciences, University of Thessaly, Larissa

16Department of Hematology, General Hospital of Serres, Serres

17Department of Hematology, University of Ioannina, Ioannina

18Department of Hematology, General Hospital of Patras “St. Andrew”, Patras

19Information Systems Unit Center of Information and Communications Technologies, University of Crete, Heraklion, Crete, Greece

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As life expectancy increases, elderly patients (pts) with immune thrombocytopenia (ITP) are increasingly being encountered in everyday practice. However, the features of ITP in older adults have not been fully elucidated thus far.

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To describe real world characteristics at diagnosis and evaluate disease outcome in a group of elderly pts (> 65 years) with primary ITP as compared to younger pts (>16 years- 65 years), using data from the national database (ITP registry) operated under the auspices of the Hellenic Society of Hematology.

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The Greek ITP registry recruits pts (n = 1317, to date) nationally through a network of 21 sites. In the present study we retrospectively analyzed data from pts with primary ITP aged over 16 years, who were diagnosed from 1979 to 2018.

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The total number of evaluable pts was 843. Pts were divided in 2 groups based on age: Group-1 consisted of 540 pts aged 16-65 years and Group-2 of 303 pts aged > 65 years. The mean age at diagnosis was 36 years (16.1-64.7) in Group-1 and 76 years (65.1-99) in Group-2. The female to male ratio in Group-1 was 1.9 and in Group-2 1.1 (P = 0.0012). The median platelet count at diagnosis was significantly higher in Group-1 (16x109/L, interquartile range: 8-35.7x109/L) than in Group-2 (12x109/L, interquartile range: 5-29x109/L; P = 0.0014). As expected, significant fewer pts in Group-1 had co-morbidities as compared to Group-2 (54.3% and 87.1%, respectively; P < 0.0001). Concurrently used medications, including vitamin K antagonists, platelet antagonists, other anticoagulants or non-steroidal anti-inflammatory drugs were more frequently reported in Group-1 than in Group-2 pts (P < 0.0001). Bleeding manifestations at diagnosis were observed at a similar frequency between the two groups, with the exception of menometrorrhagia which was significantly more frequent in Group-1 that in Group-2 pts, as expected (P < 0.0001). Bone marrow examination was performed more frequently in Group-1 pts, whereas antiphospholipid antibody, platelet associated antibody, antinuclear antibody, HIV and hepatitis C testing were more frequently performed in Group-2 pts. Treatment was given in 88% of Group-1 and in 91% of Group-2 patients at diagnosis. Overall response rate did not differ between the two Groups. A similar proportion of Group-1 and Group-2 patients were treated with corticosteroids, intravenous IgG or both, rituximab, anti-D immunoglobulin or thrombopoietin receptor agonists, whereas significant more Group-1 pts underwent splenectomy (P < 0.0001). Follow-up of at least 1 year from diagnosis revealed that a similar proportion of Group-1 and Group-2 patients had developed chronic ITP. During follow-up, 2 Group-1 pts and 11 Group-2 pts died (1.4% and 12%, respectively; P = 0.0003). Three deaths in Group-2 were considered to be related to ITP.

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Elderly pts (Group-1) presented with lower platelet counts at diagnosis had a higher frequency of comorbidities and used more often anti-platetet and anticoagulant agents. However, neither the frequency nor the location of bleeding differed between Group-1 (younger pts) and Group-2 pts. Age influenced the choice of diagnostic procedures but not that of treatment, with the exception of splenectomy which was performed at significantly lower rate in Goup-2 pts. Neither the treatment response nor the frequency of chronic ITP differed between Group-1 and Group-2 pts. 27% of deaths in Group-2 pts were ITP-related, whereas none in Group-1 pts, thereby underscoring the need for age-adapted management in elderly pts with ITP.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health Inc., on behalf of the European Hematology Association.