{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:27:41Z","timestamp":1789043261142,"version":"build-2803163510"},"reference-count":40,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2016,3,18]],"date-time":"2016-03-18T00:00:00Z","timestamp":1458259200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:p>In the last years, rituximab (RTX) and agonists of the thrombopoietin receptor (TPO\u2010R) eltrombopag and romiplostim have provided new treatment options in persistent and chronic immune thrombocytopenia (ITP). Here, we analyzed the changes in therapeutic choices over time and their impact on clinical outcomes in a cohort of 557 ITP outpatients followed at the \u201cL. and A. Ser\u00e0gnoli\u201d Institute of Hematology, Bologna, Italy, from 1980 to 2015. Overall 397 patients (71%) required front\u2010line corticosteroids, mainly prednisone. Over the decades, splenectomy was delayed from second to third\u2010line, but was steadily used in around 15\u201325% of patients refractory or relapsing after first\u2010line treatment. Consensually, RTX and TPO\u2010R agonists emerged as second and third\u2010line therapy of choice, respectively. Splenectomy was associated with the best response rates and the lower incidences of relapse, while the relapse rate after RTX was comparable to that observed with corticosteroids and other immunosuppressive agents. The introduction of TPO\u2010R agonists gave an alternative to the administration of immunosuppressive drugs and probably contributed to moderate the incidence of infectious complications that remained stable over the decades, despite an increasing use of RTX from the 2000s onwards. Overall responses were similar over time, with over 97% achieving a response in all time\u2010periods. However, the cumulative risk of bleeding significantly decreased [14.3% (1980\u201389) vs. 7% (1990\u201399) vs. 5.6% (2000\u201309) vs. 0.2% (2010\u201315)] (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), mainly thanks to the optimization of front\u2010line corticosteroids therapy and to the wider availability of second and third\u2010line therapies. Am. J. Hematol. 91:E267\u2013E272, 2016. \u00a9 2016 Wiley Periodicals, Inc.<\/jats:p>","DOI":"10.1002\/ajh.24310","type":"journal-article","created":{"date-parts":[[2016,1,23]],"date-time":"2016-01-23T00:36:41Z","timestamp":1453509401000},"source":"Crossref","is-referenced-by-count":73,"title":["Have splenectomy rate and main outcomes of ITP changed after the introduction of new treatments? A monocentric study in the outpatient setting during 35 years"],"prefix":"10.1002","volume":"91","author":[{"given":"Francesca","family":"Palandri","sequence":"first","affiliation":[{"name":"Institute of Hematology \u201cL. E A. Ser\u00e0gnoli,\u201d Department of Experimental, Diagnostic and Specialty Medicine University of Bologna  Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Polverelli","sequence":"additional","affiliation":[{"name":"Institute of Hematology \u201cL. E A. Ser\u00e0gnoli,\u201d Department of Experimental, Diagnostic and Specialty Medicine University of Bologna  Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daria","family":"Sollazzo","sequence":"additional","affiliation":[{"name":"Institute of Hematology \u201cL. E A. Ser\u00e0gnoli,\u201d Department of Experimental, Diagnostic and Specialty Medicine University of Bologna  Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Romano","sequence":"additional","affiliation":[{"name":"Institute of Hematology \u201cL. E A. Ser\u00e0gnoli,\u201d Department of Experimental, Diagnostic and Specialty Medicine University of Bologna  Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Catani","sequence":"additional","affiliation":[{"name":"Institute of Hematology \u201cL. E A. 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