TY - JOUR
T1 - American Society of Hematology 2019 guidelines for immune thrombocytopenia
AU - Neunert, Cindy
AU - Terrell, Deirdra R.
AU - Arnold, Donald M.
AU - Buchanan, George
AU - Cines, Douglas B.
AU - Cooper, Nichola
AU - Cuker, Adam
AU - Despotovic, Jenny M.
AU - George, James N.
AU - Grace, Rachael F.
AU - Kühne, Thomas
AU - Kuter, David J.
AU - Lim, Wendy
AU - McCrae, Keith R.
AU - Pruitt, Barbara
AU - Shimanek, Hayley
AU - Vesely, Sara K.
N1 - Funding Information:
1Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Irving Medical Center, New York, NY; 2Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK; 3Division of Hematology and Thromboembolism, Department of Medicine, and 4McMaster Centre for Transfusion Research, McMaster University, Toronto, ON, Canada; 5Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, TX; 6Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; 7Centre for Haematology, Department of Medicine, Hammersmith Hospital, Imperial College London, London, United Kingdom; 8Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; 9Section of Hematology-Oncology, Department of Pediatrics, College of Medicine, Baylor University, Houston, TX; 10Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Department of Pediatrics, Harvard Medical School, Boston, MA; 11University Children’s Hospital Basel, Basel, Switzerland; 12Department of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; 13Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Toronto, ON, Canada; 14Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH; 15Coral Gables, FL; and 16Ames, IA
Funding Information:
The work of this panel was coordinated by ASH and the OUHSC (funded by ASH under a paid agreement). Project oversight was provided by the ASH Committee on Quality. ASH vetted and appointed individuals to the guideline panel. OUHSC vetted and retained researchers to conduct systematic reviews of evidence
PY - 2019
Y1 - 2019
N2 - Background: Despite an increase in the number of therapies available to treat patients with immune thrombocytopenia (ITP), there are minimal data from randomized trials to assist physicians with the management of patients. Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about the management of ITP. Methods: In 2015, ASH formed a multidisciplinary guideline panel that included 8 adult clinical experts, 5 pediatric clinical experts, 2 methodologists with expertise in ITP, and 2 patient representatives. The panel was balanced to minimize potential bias from conflicts of interest. The panel reviewed the ASH 2011 guideline recommendations and prioritized questions. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including evidence-to-decision frameworks, to appraise evidence (up to May 2017) and formulate recommendations. Results: The panel agreed on 21 recommendations covering management of ITP in adults and children with newly diagnosed, persistent, and chronic disease refractory to first-line therapy who have non–life-threatening bleeding. Management approaches included: observation, corticosteroids, IV immunoglobulin, anti-D immunoglobulin, rituximab, splenectomy, and thrombopoietin receptor agonists. Conclusions: There was a lack of evidence to support strong recommendations for various management approaches. In general, strategies that avoided medication side effects were favored. A large focus was placed on shared decision-making, especially with regard to second-line therapy. Future research should apply standard corticosteroid-dosing regimens, report patient-reported outcomes, and include cost-analysis evaluations.
AB - Background: Despite an increase in the number of therapies available to treat patients with immune thrombocytopenia (ITP), there are minimal data from randomized trials to assist physicians with the management of patients. Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about the management of ITP. Methods: In 2015, ASH formed a multidisciplinary guideline panel that included 8 adult clinical experts, 5 pediatric clinical experts, 2 methodologists with expertise in ITP, and 2 patient representatives. The panel was balanced to minimize potential bias from conflicts of interest. The panel reviewed the ASH 2011 guideline recommendations and prioritized questions. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including evidence-to-decision frameworks, to appraise evidence (up to May 2017) and formulate recommendations. Results: The panel agreed on 21 recommendations covering management of ITP in adults and children with newly diagnosed, persistent, and chronic disease refractory to first-line therapy who have non–life-threatening bleeding. Management approaches included: observation, corticosteroids, IV immunoglobulin, anti-D immunoglobulin, rituximab, splenectomy, and thrombopoietin receptor agonists. Conclusions: There was a lack of evidence to support strong recommendations for various management approaches. In general, strategies that avoided medication side effects were favored. A large focus was placed on shared decision-making, especially with regard to second-line therapy. Future research should apply standard corticosteroid-dosing regimens, report patient-reported outcomes, and include cost-analysis evaluations.
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U2 - 10.1182/bloodadvances.2019000966
DO - 10.1182/bloodadvances.2019000966
M3 - Article
C2 - 31794604
AN - SCOPUS:85076343531
VL - 3
SP - 3829
EP - 3866
JO - Blood advances
JF - Blood advances
SN - 2473-9529
IS - 23
ER -