{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T03:25:16Z","timestamp":1792207516687,"version":"4.4.0"},"reference-count":69,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T00:00:00Z","timestamp":1695254400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100002429","name":"Amgen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002429","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Br J Haematol"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>Thrombopoietin receptor agonists (TPO\u2010RAs) stimulate platelet production, which might restore immunological tolerance in primary immune thrombocytopenia (ITP). The iROM study investigated romiplostim's immunomodulatory effects. Thirteen patients (median age, 31\u2009years) who previously received first\u2010line treatment received romiplostim for 22\u2009weeks, followed by monitoring until week 52. In addition to immunological data, secondary end\u2010points included the sustained remission off\u2010treatment (SROT) rate at 1\u2009year, romiplostim dose, platelet count and bleedings. Scheduled discontinuation of romiplostim and SROT were achieved in six patients with newly diagnosed ITP, whereas the remaining seven patients relapsed. Romiplostim dose titration was lower and platelet count response was stronger in patients with SROT than in relapsed patients. In all patients, regulatory T lymphocyte (Treg) counts increased until study completion and the counts were higher in patients with SROT. Interleukin (IL)\u20104, IL\u20109 and IL\u201017F levels decreased significantly in all patients. FOXP3 (Treg), GATA3 (Th2) mRNA expression and transforming growth factor\u2010\u03b2 levels increased in patients with SROT. Treatment with romiplostim modulates the immune system and possibly influences ITP prognosis. A rapid increase in platelet counts is likely important for inducing immune tolerance. Better outcomes might be achieved at an early stage of autoimmunity, but clinical studies are needed for confirmation.<\/jats:p>","DOI":"10.1111\/bjh.19074","type":"journal-article","created":{"date-parts":[[2023,9,22]],"date-time":"2023-09-22T03:20:29Z","timestamp":1695352829000},"page":"119-130","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Immunomodulation with romiplostim as a second\u2010line strategy in primary immune thrombocytopenia: The <scp>iROM<\/scp> study"],"prefix":"10.1111","volume":"203","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9459-8709","authenticated-orcid":false,"given":"Alexandra","family":"Schifferli","sequence":"first","affiliation":[{"name":"Department of Hematology\/Oncology University Children's Hospital Basel  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"R\u00fcfer","sequence":"additional","affiliation":[{"name":"Department of Hematology, Cantonal Hospital Lucerne  Lucerne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7757-4753","authenticated-orcid":false,"given":"Alicia","family":"Rovo","sequence":"additional","affiliation":[{"name":"Department of Hematology and Central Hematology Laboratory, Inselspital Bern University Hospital, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Falk","family":"Nimmerjahn","sequence":"additional","affiliation":[{"name":"Department of Biology, Institute of Genetics University of Erlangen\u2010N\u00fcrnberg  Erlangen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Cantoni","sequence":"additional","affiliation":[{"name":"Department of Hematology Cantonal Hospital Aarau  Aarau Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Holbro","sequence":"additional","affiliation":[{"name":"Department of Hematology University Hospital Basel  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genevi\u00e8ve","family":"Favre","sequence":"additional","affiliation":[{"name":"Department of Hematology Cantonal Hospital Liestal  Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Dirks","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine University Hospital Basel  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Wieland","sequence":"additional","affiliation":[{"name":"Department of Hematology and Central Hematology Laboratory, Inselspital Bern University Hospital, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heike","family":"Faeth","sequence":"additional","affiliation":[{"name":"Medical University of Basel  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata","family":"Pereira","sequence":"additional","affiliation":[{"name":"Medical University of Basel  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7387-7028","authenticated-orcid":false,"given":"Thomas","family":"K\u00fchne","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology University Children's Hospital Basel  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,21]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2013.03.001"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/10245332.2016.1219497"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-0502(03)00041-7"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V87.10.4245.bloodjournal87104245"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V128.22.2549.2549"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019000966"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.13319"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.13221"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2018.212845"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-12-309153"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12185-015-1793-1"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.12139"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.13827"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.4081\/hr.2011.e20"},{"key":"e_1_2_13_16_1","article-title":"Sustained remission in patients with primary immune thrombocytopenia after romiplostim tapering and discontinuation: a case series in real life management in Spain","volume":"2017","author":"Mingot\u2010Castellano ME","year":"2017","journal-title":"Case Rep Hematol"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.12888"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12185-020-02893-y"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2019.100647"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V120.21.1085.1085"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V126.23.1054.1054"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.23900"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.17334"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1179\/1607845415Y.0000000041"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.15803"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-01-549360"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.16327"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-04-281717"},{"key":"e_1_2_13_29_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fimmu.2019.01196","article-title":"Immunomodulation in primary immune thrombocytopenia: a possible role of the Fc fragment of romiplostim?","volume":"10","author":"Schifferli A","year":"2019","journal-title":"Front Immunol"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminhematol.2016.04.010"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22094492"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)04143-3"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.imlet.2014.03.002"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10875-007-9111-1"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.12822"},{"key":"e_1_2_13_36_1","doi-asserted-by":"publisher","DOI":"10.1080\/09537104.2016.1235691"},{"key":"e_1_2_13_37_1","doi-asserted-by":"publisher","DOI":"10.1101\/cshperspect.a022236"},{"key":"e_1_2_13_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cyto.2014.09.011"},{"key":"e_1_2_13_39_1","doi-asserted-by":"publisher","DOI":"10.1177\/0300060520976477"},{"key":"e_1_2_13_40_1","doi-asserted-by":"publisher","DOI":"10.1089\/jir.2021.0147"},{"key":"e_1_2_13_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humimm.2014.06.019"},{"key":"e_1_2_13_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.13292"},{"key":"e_1_2_13_43_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-018-3556-6"},{"key":"e_1_2_13_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12185-017-2207-3"},{"key":"e_1_2_13_45_1","doi-asserted-by":"publisher","DOI":"10.1080\/09537104.2017.1394451"},{"key":"e_1_2_13_46_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-011-1249-5"},{"key":"e_1_2_13_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.16164"},{"key":"e_1_2_13_48_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V98.4.1047"},{"key":"e_1_2_13_49_1","doi-asserted-by":"publisher","DOI":"10.1038\/35393"},{"key":"e_1_2_13_50_1","doi-asserted-by":"publisher","DOI":"10.1080\/10245330701383957"},{"key":"e_1_2_13_51_1","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/6804806"},{"key":"e_1_2_13_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2020.100774"},{"key":"e_1_2_13_53_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-88900-6"},{"key":"e_1_2_13_54_1","doi-asserted-by":"publisher","DOI":"10.1080\/09537104.2019.1624709"},{"key":"e_1_2_13_55_1","doi-asserted-by":"publisher","DOI":"10.1098\/rspb.1964.0093"},{"key":"e_1_2_13_56_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-bioeng-110315-020137"},{"key":"e_1_2_13_57_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.657768"},{"key":"e_1_2_13_58_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-04-348144"},{"key":"e_1_2_13_59_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.16959"},{"key":"e_1_2_13_60_1","doi-asserted-by":"publisher","DOI":"10.1038\/nri724"},{"key":"e_1_2_13_61_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019000868"},{"key":"e_1_2_13_62_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2009-07-229815"},{"key":"e_1_2_13_63_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12185-010-0753-z"},{"key":"e_1_2_13_64_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.12102"},{"key":"e_1_2_13_65_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2012-09-455691"},{"key":"e_1_2_13_66_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.15070"},{"key":"e_1_2_13_67_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.26210"},{"key":"e_1_2_13_68_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.613192"},{"key":"e_1_2_13_69_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2021-147218"},{"key":"e_1_2_13_70_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-024427"}],"container-title":["British Journal of Haematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bjh.19074","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,23]],"date-time":"2023-11-23T18:36:54Z","timestamp":1700764614000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/bjh.19074"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,21]]},"references-count":69,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1111\/bjh.19074"],"URL":"https:\/\/doi.org\/10.1111\/bjh.19074","archive":["Portico"],"relation":{},"ISSN":["0007-1048","1365-2141"],"issn-type":[{"value":"0007-1048","type":"print"},{"value":"1365-2141","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,21]]},"assertion":[{"value":"2023-06-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-19","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-21","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}