The association of lymphocyte phenotypes and outcomes after
discontinuing eltrombopag in ITP
Abstract
Eltrombopag is a highly effective treatment for immune thrombocytopenia
(ITP). Cases of durable remission after the discontinuation of
eltrombopag in adult ITP have recently been reported; however, the
frequency and mechanisms responsible for this phenomenon remain unknown.
In the present study, we examined the phenotypes of lymphocytes in ITP
to clarify whether they predict outcomes after the discontinuation of
eltrombopag. We examined 56 adult newly diagnosed ITP patients treated
with eltrombopag after a median time from diagnosis of 48 months. Among
the 38 patients who achieved complete remission, eltrombopag was
discontinued in 26. Among the 26 patients, 12 (46.2%) had an immediate
relapse after discontinuing eltrombopag and 16 (53.8%) showed sustained
response without additional ITP therapy, despite discontinuing
eltrombopag, with a median follow-up of 52 months. No significant
differences were observed in platelets, the median duration of
eltrombopag, the absolute number of T, B, and NK cells at the initiation
of eltrombopag between patients who sustained response and those who
relapsed after discontinuing eltrombopag. However, the number of B and
NK cells at the discontinuation of eltrombopag was higher in patients
who sustained response than in those who relapsed (p=0.022 and p=0.012,
respectively). The present results indicate that the absolute number of
B (≥ 0.20 x 109/L) and NK (≥ 0.36 x 109/L) cells at the discontinuation
of eltrombopag contributes to the prediction of outcomes.