{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T06:24:37Z","timestamp":1787379877154,"version":"build-2736575974"},"reference-count":48,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Br J Haematol"],"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Patients with immune thrombocytopenia (ITP) exhibit substantial heterogeneity in treatment responses. Approximately 30%\u201350% of patients maintain remission after discontinuation of thrombopoietin receptor agonists (TPO\u2010RA), suggesting immunomodulatory effects beyond enhanced thrombopoiesis. However, predictive or explanatory biomarkers for sustained remission after TPO\u2010RA are currently lacking. In this study, we performed spectral flow cytometry on B cells of longitudinal samples from patients before, during and after treatment with the TPO\u2010RA romiplostim. We observed that anergic B cells were the predominant B cell population within the peripheral blood in romiplostim\u2010na\u00efve patients (mean: 51.7%) and in healthy controls (mean: 47.8%). Paired longitudinal analyses showed a significant increase in anergic B cells during romiplostim treatment, with values exceeding those of healthy controls after 1\u2009year of treatment (mean: 58.4%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.006). After tapering, the anergic B cells remained stably increased (mean: 59.7%), both in treatment\u2010free patients as well as patients who restarted romiplostim. Within the switched\u2010 and antibody\u2010secreting cell (ASC) compartment, a decrease of immunoglobulin G (IgG\n                    <jats:sup>+<\/jats:sup>\n                    ) and immunoglobulin A (IgA\n                    <jats:sup>+<\/jats:sup>\n                    ) ASC was observed during romiplostim (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.04 and\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.08). These results reveal a previously unappreciated potential role for anergic B cells and ASCs in ITP and emphasize the need for further investigations of TPO\u2010RA\u2010induced B cell responses in ITP.\n                  <\/jats:p>","DOI":"10.1111\/bjh.70762","type":"journal-article","created":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T06:02:22Z","timestamp":1787378542000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Increased anergic B cells and decreased antibody\u2010secreting cells during romiplostim treatment in patients with immune thrombocytopenia"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7329-2687","authenticated-orcid":false,"given":"Vivianne S.","family":"Nelson","sequence":"first","affiliation":[{"name":"Sanquin Blood Supply Foundation, Department Research Amsterdam UMC Location University of Amsterdam, Landsteiner Laboratory  Amsterdam The Netherlands"},{"name":"Department of Hematology Haga Teaching Hospital  the Hague The Netherlands"},{"name":"Department of Hematology Leiden University Medical Center (LUMC)  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0348-3223","authenticated-orcid":false,"given":"Rebeca","family":"Guti\u00e9rrez\u2010C\u00f3zar","sequence":"additional","affiliation":[{"name":"Sanquin Blood Supply Foundation, Department Research Amsterdam UMC Location University of Amsterdam, Landsteiner Laboratory  Amsterdam The Netherlands"},{"name":"Amsterdam Institute for Immunology and Infectious Diseases  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6813-0894","authenticated-orcid":false,"given":"Rebecca","family":"Cornelis","sequence":"additional","affiliation":[{"name":"Sanquin Blood Supply Foundation, Department Research Amsterdam UMC Location University of Amsterdam, Landsteiner Laboratory  Amsterdam The Netherlands"},{"name":"Amsterdam Institute for Immunology and Infectious Diseases  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Marieke","family":"van Ham","sequence":"additional","affiliation":[{"name":"Sanquin Blood Supply Foundation, Department Research Amsterdam UMC Location University of Amsterdam, Landsteiner Laboratory  Amsterdam The Netherlands"},{"name":"Amsterdam Institute for Immunology and Infectious Diseases  Amsterdam The Netherlands"},{"name":"Swammerdam Institute for Life Sciences, University of Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0135-7496","authenticated-orcid":false,"given":"Anja","family":"ten Brinke","sequence":"additional","affiliation":[{"name":"Sanquin Blood Supply Foundation, Department Research Amsterdam UMC Location University of Amsterdam, Landsteiner Laboratory  Amsterdam The Netherlands"},{"name":"Amsterdam Institute for Immunology and Infectious Diseases  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1608-876X","authenticated-orcid":false,"given":"Rick","family":"Kapur","sequence":"additional","affiliation":[{"name":"Sanquin Blood Supply Foundation, Department Research Amsterdam UMC Location University of Amsterdam, Landsteiner Laboratory  Amsterdam The Netherlands"},{"name":"Amsterdam Institute for Immunology and Infectious Diseases  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"issue":"6","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1097\/MOH.0000000000000612","article-title":"An update on the pathophysiology of immune thrombocytopenia","volume":"27","author":"Semple JW","year":"2020","journal-title":"Curr Opin 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