ISSN 2997-1036
International Journal of Hematology | Vol. 1, No. 3, March 2010 | pp. 17–24
DOI: 10.46882/2010/IJH/000003
Review Article
Title: Emerging paradigms in the management of immune thrombocytopenia refractory to first-line therapies
Names of Authors: M. N. Salami¹, O. P. Danladi²
Authors’ Affiliations: ¹Division of Hematology and Blood Transfusion, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria; ²Department of Haematology, University of Benin, Benin City, Nigeria
Abstract: Immune thrombocytopenia presents complex therapeutic dilemmas when standard corticosteroid and intravenous immunoglobulin regimens fail. This comprehensive review synthesizes recent clinical trial evidence regarding thrombopoietin receptor agonists, rituximab protocols, and targeted splenic tyrosine kinase inhibitors. Mechanism-based evaluations show that romiplostim and eltrombopag achieve sustained platelet elevation (> 50 × 10⁹/L) in 60% to 80% of refractory cases, tapering the necessity for chronic immunosuppression or splenectomy. Combination approaches incorporating low-dose rituximab with cyclosporine demonstrate promising remission durability, though long-term infection risks warrant rigorous monitoring. Furthermore, evolving biomarkers regarding platelet autoantibody specificity help predict therapeutic responsiveness before transitioning to second-line and third-line interventions. Management algorithms now favor individualized risk-benefit stratification, balancing bleeding scores against adverse drug profiles. Ongoing trials investigating neonatal Fc receptor antagonists represent the next frontier in minimizing pathogenic autoantibody recycling. This review outlines a practical decision-making framework for hematologists handling treatment-refractory immune thrombocytopenia in diverse clinical environments.
Keywords: Immune thrombocytopenia, refractory, thrombopoietin receptor agonists, splenectomy, rituximab
Manuscript Timeline: Received: December 01, 2009; Revised: January 11, 2010; Accepted: February 02, 2010; Published: March 15, 2010