Response Rate and Duration After Discontinuation Thrombopoietin Receptor Agonists Primary Immune Thrombocytopenia

Brief Summary: The primary objective of the study is the evaluation of sustained response rate after discontinuation of treatment with TPO-RAs, Eltrombopag and Romiplostim, in persistent or chronic pITP patients who failed one or more therapy lines, splenectomy included.

Detailed Description: Increasing evidence exists in the literature on the persistent response after TPO-RAs discontinuation. However, the available data consist of description of case reports from different patients' series. At this time, systematic data collections on this topic do not exist and the real incidence of such persistent response is unknown. Therefore, because of the increasing interest in this new and challenging therapeutic field, also for the therapeutic implications, we would like to investigate the impact of TPO- RAs on the achievement of sustained and persistent responses after their discontinuation in the Italian adult patients affected by pITP who have been referred to the GIMEMA Centers.

Recruitment & Eligibility

Inclusion Criteria

Signed written informed consent according to ICH/EU/GCP and national local laws;
Persistent or chronic pITP adult patients who have been treated with TPO-RAs therapy after failure of one or more therapy lines, splenectomy included;
Age > 18 years.

Exclusion Criteria

Active malignancy;
Active malignancy;
HCVAb, HIVAb, HBsAg, HBcAb seropositive status;
Chronic liver disease;
Treatment with Rituximab less than 8 weeks before TPO-RAs start;
Recent splenectomy (less than 8 weeks) before TPO-RAs start. Active malignancy;
HCVAb, HIVAb, HBsAg, HBcAb seropositive status;
Chronic liver disease;
Treatment with Rituximab less than 8 weeks before TPO-RAs start;
Recent splenectomy (less than 8 weeks) before TPO-RAs start. HCVAb, HIVAb, HBsAg, HBcAb seropositive status;
Chronic liver disease;
Treatment with Rituximab less than 8 weeks before TPO-RAs start;
Recent splenectomy (less than 8 weeks) before TPO-RAs start.

Primary Outcome Measures

Name	Time	Method
Estimation of sustained response rate after discontinuation of treatment with TPO-RAs in terms of patients still alive in Complete Response or R at more than 4 weeks after discontinuation.	One year from start of recruitment.

Secondary Outcome Measures

Name	Time	Method
Estimation of incidence of relapse and loss of response at 6 and 12 months after sustained response achievement.	One year from start of recruitment.
Description of Platelet levels and TPO-RAs dosage at stop.	One year from start of recruitment.
Description of patients' characteristics in term of: biological and clinical features, disease duration at the beginning of TPO-RAs, number and type of therapy lines preceding TPO-RAs treatment, platelet levels at TPO-RAs start.	One year from start of recruitment.
Assessment of an association between previous splenectomy and sustained response after discontinuation of treatment with TPO-RAs.	One year from start of recruitment.
Frequency of the type of response in patients treated with TPO-RAs in absence of concomitant or rescue medication, in order to estimate the rate of Response (R) and Complete Response (CR).	One year from start of recruitment.
Estimation of the suspension criteria in terms of frequency of discontinuation causes for each center.	One year from start of recruitment.
Estimation of the duration of sustained response in terms of patients alive in CR or R at 6 and 12 months after sustained response achievement.	One year from start of recruitment.
Estimation of treatment duration starting from the date of first dose of TPO-RAs.	One year from start of recruitment.
Description of concomitant therapies since TPO-RAs start in terms of type and duration of therapies.	One year from start of recruitment.

Locations (13): Clinica Medica III - Padiglione ex isolamento - Azienda Ospedale Università San Martino
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Genova, Italy
Unità Operativa Complessa di Ematologia - Arcispedale S. Maria Nuova
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Reggio Emilia, Italy
Università Cattolica del Sacro Cuore - Policlinico A. Gemelli
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Roma, Italy
S.O.C. di Medicina Interna B - Ospedale - Cardinal Massaia di Asti
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Asti, Italy
ASL Le/1 P.O. Vito Fazzi - U.O. di Ematologia ed UTIE
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Lecce, Italy
Unità di Ricerca e di Malattie del sangue - Ematologia San Luca Vecchio Pad. 16 - 1° Piano
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Firenze, Italy
Istituto di Ematologia "Lorenzo e A. Seragnoli"
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Bologna, Italy
Unità di Onco-Ematologia - Azienda Ospedaliera - Garibaldi
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Catania, Italy
Università degli studi "Sapienza" di Roma
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Rome, Italy
Azienda Ospedaliera "S.Gerardo"
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Monza, Italy
Ematologia - Ospedale San Carlo
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Potenza, Italy
U.O.C. Ematologia - Ospedale S. Eugenio
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Rome, Italy
Ematologia - Dipartimento di Medicina Clinica e Sperimentale
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Sassari, Italy