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Treatment Guidelines for Relapsed/Refractory ITP

Panelists: Ivy Altomare, MD, Duke University Medical Center; Terry Gernsheimer, MD, Fred Hutchingson Cancer Research Center; Keith R McCrae, MD, The Cleveland Clinic
Published: Friday, Feb 09, 2018



Transcript:

Ivy Altomare, MD: I would like to discuss the guidelines. There are ASH guidelines. There are also international consensus guidelines for the management of idiopathic thrombocytopenia purpura. Dr. McCrae, can you go into the guidelines? Do you think people use or refer to the guidelines? I heard that there will be a new version of the ASH guidelines, which will be published shortly.

Keith R. McCrae, MD: I do think people use the guidelines. Actually, there’s both International Working Group guidelines and ASH guidelines. There’s a separate publication from the International Working Group that preceded the guidelines, per se, just to go over the nomenclature of ITP. I think that is actually one of the most helpful papers of all in defining what is. We don’t really use the term as much as we used to, acute ITP. It’s now newly diagnosed ITP, or so on and so forth. I won’t go through all of those. But I think people do refer to the guidelines. The ASH guidelines were published in, I believe, 2011. Much has happened since then. So, clearly, we’re in need of new guidelines. There is a guideline development group that’s working on this. I really can’t say much more than that right now.

Ivy Altomare, MD: Are you on the panel?

Keith R. McCrae, MD: I’m on the panel. I suspect we’ll probably see these by maybe the second quarter of next year.

Ivy Altomare, MD: So, you can’t say anything? You can’t say if it’s going to be much different from the prior version?

Keith R. McCrae, MD: Oh, it’ll be different. It’ll definitely be different.

Ivy Altomare, MD: Well you said a lot has happened?

Keith R. McCrae, MD: A lot has happened. It’ll definitely be different and, hopefully, more complete. There’s a lot of emphasis in trying to make it helpful to the clinician, which I think is important.

Ivy Altomare, MD: Yes.

Terry Gernsheimer, MD: I think there was a problem with the last set of ASH guidelines versus what the International Working Group did. You know, there’s very little data on head-to-head trials. This was part of the problem. With the ASH guidelines, they were really looking for data-driven trials. They don’t exist. Some of that has changed. I always liked our secondary drugs because we put them in alphabetical order. There’s a very long list. And the reason we did that was we had to say, “There are reports that all of these can work. But we cannot tell you that one is necessarily better than the other, other than the use of the TPO mimetics, rituximab, and splenectomy.” I’m trying to remember if there was another. Other than that, there were really not good enough data. I’m hoping that the new guidelines are going to address that a little bit better, the drugs that we use when we’re out of ideas.

Ivy Altomare, MD: Sure. Right.

Transcript Edited for Clarity 

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Transcript:

Ivy Altomare, MD: I would like to discuss the guidelines. There are ASH guidelines. There are also international consensus guidelines for the management of idiopathic thrombocytopenia purpura. Dr. McCrae, can you go into the guidelines? Do you think people use or refer to the guidelines? I heard that there will be a new version of the ASH guidelines, which will be published shortly.

Keith R. McCrae, MD: I do think people use the guidelines. Actually, there’s both International Working Group guidelines and ASH guidelines. There’s a separate publication from the International Working Group that preceded the guidelines, per se, just to go over the nomenclature of ITP. I think that is actually one of the most helpful papers of all in defining what is. We don’t really use the term as much as we used to, acute ITP. It’s now newly diagnosed ITP, or so on and so forth. I won’t go through all of those. But I think people do refer to the guidelines. The ASH guidelines were published in, I believe, 2011. Much has happened since then. So, clearly, we’re in need of new guidelines. There is a guideline development group that’s working on this. I really can’t say much more than that right now.

Ivy Altomare, MD: Are you on the panel?

Keith R. McCrae, MD: I’m on the panel. I suspect we’ll probably see these by maybe the second quarter of next year.

Ivy Altomare, MD: So, you can’t say anything? You can’t say if it’s going to be much different from the prior version?

Keith R. McCrae, MD: Oh, it’ll be different. It’ll definitely be different.

Ivy Altomare, MD: Well you said a lot has happened?

Keith R. McCrae, MD: A lot has happened. It’ll definitely be different and, hopefully, more complete. There’s a lot of emphasis in trying to make it helpful to the clinician, which I think is important.

Ivy Altomare, MD: Yes.

Terry Gernsheimer, MD: I think there was a problem with the last set of ASH guidelines versus what the International Working Group did. You know, there’s very little data on head-to-head trials. This was part of the problem. With the ASH guidelines, they were really looking for data-driven trials. They don’t exist. Some of that has changed. I always liked our secondary drugs because we put them in alphabetical order. There’s a very long list. And the reason we did that was we had to say, “There are reports that all of these can work. But we cannot tell you that one is necessarily better than the other, other than the use of the TPO mimetics, rituximab, and splenectomy.” I’m trying to remember if there was another. Other than that, there were really not good enough data. I’m hoping that the new guidelines are going to address that a little bit better, the drugs that we use when we’re out of ideas.

Ivy Altomare, MD: Sure. Right.

Transcript Edited for Clarity 
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