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Talley Talks Treatment Strategies in ITP and TTP

Caroline Seymour
Published: Monday, Feb 11, 2019

Robert L. Talley, MD

Robert L. Talley, MD

Although the presentations of idiopathic thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP) differ, therapies for both blood disorders are greatly needed for patients who have exhausted the current available treatments, explained Robert L. Talley, MD.

State of the Science Summit™ on Hematologic Malignancies, Talley, a hematologist/medical oncologist at Centerpoint Medical Center, Sarah Cannon Cancer Institute, discussed current and potential future standards of care in IPT and TTP.

OncLive®: What have been the most notable advancements in ITP?

Talley: Fostamatinib represents a brand new way to help people achieve a better platelet count so that they don't have bleeding or bruising; it supplements and compliments other modalities that patients may have exhausted.

What are the challenges with diagnosing TTP and ITP? How do these blood diseases present?

ITP is more or less a diagnosis of exclusion. If a patient has a low isolated platelet count and no other primary disease, then ITP becomes a diagnosis of exclusion. Serologic testing is something that has been discussed for a long time and was a subject of an ASH Clinical Practice Guidelines report in 2011. I wonder if it’s going to find more prominence over time. One doesn't need to do a bone marrow examination, but if there are other complicating medical diagnoses, then it's probably a good idea to do a bone marrow examination.

TTP is different altogether; it's sudden, explosive, and fatal as opposed to ITP, unless the platelet count is extremely low. In TTP, one has to make a diagnosis quickly. Even with the best therapies, there is still a [significant] mortality rate. Many of those patients are not old with many comorbidities; they are otherwise healthy.

What are other challenges that exist in these diseases?

There are some patients with ITP who are refractory to all of the therapies that we have. Steroids are great therapies; you can see a short-term response in about 70% of patients who are treated with high-dose steroids. Complications from steroids begin to be [accumulate] when patients need continuous steroids.
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