{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T14:06:51Z","timestamp":1780927611801,"version":"3.54.1"},"reference-count":46,"publisher":"American Society of Hematology","issue":"1","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,12,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Immune thrombocytopenia resulting from antibody-mediated platelet destruction combined with impaired platelet production is a common cause of thrombocytopenia. The decision to treat newly diagnosed patients is based on several factors including ceasing hemorrhagic manifestations, increasing the platelet count, prevention of bleeding, and inducing remission. Current standard first-line therapy is a course of corticosteroids. Although this treatment paradigm increases the platelet count in the majority of patients, a high percentage relapse after discontinuation of corticosteroid therapy. For this reason, intensification of first-line therapy that results in superior long-term remission rates would be desirable. This manuscript focuses primarily on adults with idiopathic thrombocytopenic purpura (ITP), highlighting pediatric data and practice when applicable. The primary aim is to outline upfront strategies for treatment-naive patients with ITP to enhance remission rates, taking into account assessment of the risks and benefits of these approaches.<\/jats:p>","DOI":"10.1182\/asheducation-2017.1.400","type":"journal-article","created":{"date-parts":[[2019,4,16]],"date-time":"2019-04-16T22:13:11Z","timestamp":1555452791000},"page":"400-405","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":23,"title":["Management of newly diagnosed immune thrombocytopenia: can we change outcomes?"],"prefix":"10.1182","volume":"2017","author":[{"given":"Cindy E.","family":"Neunert","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Columbia University Medical Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","reference":[{"issue":"3","key":"2019111704221337300_B1","first-page":"174","article-title":"The incidence of immune thrombocytopenic purpura in children and adults: a critical review of published reports","volume":"85","author":"Terrell","year":"2010","journal-title":"Am J Hematol"},{"issue":"8","key":"2019111704221337300_B2","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1111\/jth.13019","article-title":"Severe bleeding events in adults and children with primary immune thrombocytopenia: a systematic review: reply.","volume":"13","author":"Neunert","year":"2015","journal-title":"J Thromb Haemost"},{"issue":"10","key":"2019111704221337300_B3","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1002\/ajh.23299","article-title":"Platelet count or bleeding as the outcome in ITP trials?","volume":"87","author":"Arnold","year":"2012","journal-title":"Am J Hematol"},{"issue":"4","key":"2019111704221337300_B4","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1055\/s-0034-1544001","article-title":"Can immune thrombocytopenia be cured with medical therapy?","volume":"41","author":"Cuker","year":"2015","journal-title":"Semin Thromb Hemost"},{"issue":"14","key":"2019111704221337300_B5","doi-asserted-by":"crossref","first-page":"2596","DOI":"10.1182\/blood-2012-07-442392","article-title":"Standardization of bleeding assessment in immune thrombocytopenia: report from the International Working Group","volume":"121","author":"Rodeghiero","year":"2013","journal-title":"Blood"},{"issue":"16","key":"2019111704221337300_B6","doi-asserted-by":"crossref","first-page":"4190","DOI":"10.1182\/blood-2010-08-302984","article-title":"The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia","volume":"117","author":"Neunert","year":"2011","journal-title":"Blood"},{"issue":"24","key":"2019111704221337300_B7","doi-asserted-by":"crossref","first-page":"3524","DOI":"10.1182\/blood-2014-09-599399","article-title":"Five hematologic tests and treatments to question","volume":"124","author":"Hicks","year":"2014","journal-title":"Blood"},{"issue":"10","key":"2019111704221337300_B8","doi-asserted-by":"crossref","first-page":"4003","DOI":"10.1182\/blood-2008-03-138487","article-title":"Severe hemorrhage in children with newly diagnosed immune thrombocytopenic purpura","volume":"112","author":"Neunert","year":"2008","journal-title":"Blood"},{"issue":"2","key":"2019111704221337300_B9","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1182\/blood-2009-06-225565","article-title":"International consensus report on the investigation and management of primary immune thrombocytopenia","volume":"115","author":"Provan","year":"2010","journal-title":"Blood"},{"issue":"11","key":"2019111704221337300_B10","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1001\/archinte.160.11.1630","article-title":"The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts","volume":"160","author":"Cohen","year":"2000","journal-title":"Arch Intern Med"},{"issue":"10","key":"2019111704221337300_B11","doi-asserted-by":"crossref","first-page":"e489","DOI":"10.1016\/S2352-3026(16)30109-0","article-title":"High-dose dexamethasone compared with prednisone for previously untreated primary immune thrombocytopenia: a systematic review and meta-analysis","volume":"3","author":"Mithoowani","year":"2016","journal-title":"Lancet Haematol"},{"issue":"2","key":"2019111704221337300_B12","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1042\/bst0250705","article-title":"Targeted anti-cancer therapy using rituximab, a chimaeric anti-CD20 antibody (IDEC-C2B8) in the treatment of non-Hodgkin\u2019s B-cell lymphoma","volume":"25","author":"Anderson","year":"1997","journal-title":"Biochem Soc Trans"},{"issue":"8","key":"2019111704221337300_B13","doi-asserted-by":"crossref","first-page":"2924","DOI":"10.1182\/blood-2007-02-068999","article-title":"Response to B-cell depleting therapy with rituximab reverts the abnormalities of T-cell subsets in patients with idiopathic thrombocytopenic purpura","volume":"110","author":"Stasi","year":"2007","journal-title":"Blood"},{"issue":"4","key":"2019111704221337300_B14","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1182\/blood-2007-12-129262","article-title":"Analysis of regulatory T-cell changes in patients with idiopathic thrombocytopenic purpura receiving B cell-depleting therapy with rituximab","volume":"112","author":"Stasi","year":"2008","journal-title":"Blood"},{"issue":"25","key":"2019111704221337300_B15","doi-asserted-by":"crossref","first-page":"5989","DOI":"10.1182\/blood-2011-11-393975","article-title":"Outcomes 5 years after response to rituximab therapy in children and adults with immune thrombocytopenia","volume":"119","author":"Patel","year":"2012","journal-title":"Blood"},{"issue":"2","key":"2019111704221337300_B16","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1111\/j.1365-2141.2004.04889.x","article-title":"The efficacy and safety of B-cell depletion with anti-CD20 monoclonal antibody in adults with chronic immune thrombocytopenic purpura","volume":"125","author":"Cooper","year":"2004","journal-title":"Br J Haematol"},{"issue":"1","key":"2019111704221337300_B17","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1007\/s12185-010-0753-z","article-title":"Low-dose rituximab combined with short-term glucocorticoids up-regulates Treg cell levels in patients with immune thrombocytopenia","volume":"93","author":"Li","year":"2011","journal-title":"Int J Hematol"},{"issue":"14","key":"2019111704221337300_B18","doi-asserted-by":"crossref","first-page":"2755","DOI":"10.1182\/blood-2009-07-229815","article-title":"Dexamethasone plus rituximab yields higher sustained response rates than dexamethasone monotherapy in adults with primary immune thrombocytopenia","volume":"115","author":"Zaja","year":"2010","journal-title":"Blood"},{"issue":"11","key":"2019111704221337300_B19","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.1182\/blood-2012-09-455691","article-title":"Rituximab and dexamethasone vs dexamethasone monotherapy in newly diagnosed patients with primary immune thrombocytopenia","volume":"121","author":"Gudbrandsdottir","year":"2013","journal-title":"Blood"},{"issue":"6","key":"2019111704221337300_B20","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1182\/blood-2011-08-374777","article-title":"A pilot randomized trial of adjuvant rituximab or placebo for nonsplenectomized patients with immune thrombocytopenia","volume":"119","author":"Arnold","year":"2012","journal-title":"Blood"},{"issue":"6","key":"2019111704221337300_B21","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1111\/ejh.12102","article-title":"High response rate to low-dose rituximab plus high-dose dexamethasone as frontline therapy in adult patients with primary immune thrombocytopenia","volume":"90","author":"G\u00f3mez-Almaguer","year":"2013","journal-title":"Eur J Haematol"},{"issue":"11","key":"2019111704221337300_B22","doi-asserted-by":"crossref","first-page":"1946","DOI":"10.1182\/blood-2013-04-494096","article-title":"The effect of rituximab on vaccine responses in patients with immune thrombocytopenia","volume":"122","author":"Nazi","year":"2013","journal-title":"Blood"},{"issue":"1","key":"2019111704221337300_B23","doi-asserted-by":"crossref","first-page":"25","DOI":"10.7326\/0003-4819-146-1-200701020-00006","article-title":"Systematic review: efficacy and safety of rituximab for adults with idiopathic thrombocytopenic purpura","volume":"146","author":"Arnold","year":"2007","journal-title":"Ann Intern Med"},{"issue":"1","key":"2019111704221337300_B24","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1182\/blood-2010-10-313908","article-title":"A randomized, double-blind study of romiplostim to determine its safety and efficacy in children with immune thrombocytopenia","volume":"118","author":"Bussel","year":"2011","journal-title":"Blood"},{"issue":"8","key":"2019111704221337300_B25","doi-asserted-by":"crossref","first-page":"e315","DOI":"10.1016\/S2352-3026(15)00114-3","article-title":"Eltrombopag for the treatment of children with persistent and chronic immune thrombocytopenia (PETIT): a randomised, multicentre, placebo-controlled study","volume":"2","author":"Bussel","year":"2015","journal-title":"Lancet Haematol"},{"issue":"2","key":"2019111704221337300_B26","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1002\/pbc.25136","article-title":"Long-term use of the thrombopoietin-mimetic romiplostim in children with severe chronic immune thrombocytopenia (ITP)","volume":"62","author":"Bussel","year":"2015","journal-title":"Pediatr Blood Cancer"},{"issue":"9664","key":"2019111704221337300_B27","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/S0140-6736(09)60402-5","article-title":"Effect of eltrombopag on platelet counts and bleeding during treatment of chronic idiopathic thrombocytopenic purpura: a randomised, double-blind, placebo-controlled trial","volume":"373","author":"Bussel","year":"2009","journal-title":"Lancet"},{"issue":"9763","key":"2019111704221337300_B28","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/S0140-6736(10)60959-2","article-title":"Eltrombopag for management of chronic immune thrombocytopenia (RAISE): a 6-month, randomised, phase 3 study","volume":"377","author":"Cheng","year":"2011","journal-title":"Lancet"},{"issue":"10004","key":"2019111704221337300_B29","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.1016\/S0140-6736(15)61107-2","article-title":"Eltrombopag for children with chronic immune thrombocytopenia (PETIT2): a randomised, multicentre, placebo-controlled trial","volume":"386","author":"Grainger","year":"2015","journal-title":"Lancet"},{"issue":"9610","key":"2019111704221337300_B30","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/S0140-6736(08)60203-2","article-title":"Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: a double-blind randomised controlled trial","volume":"371","author":"Kuter","year":"2008","journal-title":"Lancet"},{"issue":"3","key":"2019111704221337300_B31","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1111\/bjh.12260","article-title":"Long-term treatment with romiplostim in patients with chronic immune thrombocytopenia: safety and efficacy","volume":"161","author":"Kuter","year":"2013","journal-title":"Br J Haematol"},{"issue":"3","key":"2019111704221337300_B32","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1182\/blood-2012-04-425512","article-title":"Safety and efficacy of eltrombopag for treatment of chronic immune thrombocytopenia: results of the long-term, open-label EXTEND study","volume":"121","author":"Saleh","year":"2013","journal-title":"Blood"},{"issue":"10039","key":"2019111704221337300_B33","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S0140-6736(16)00279-8","article-title":"Romiplostim in children with immune thrombocytopenia: a phase 3, randomised, double-blind, placebo-controlled study","volume":"388","author":"Tarantino","year":"2016","journal-title":"Lancet"},{"issue":"22","key":"2019111704221337300_B34","doi-asserted-by":"crossref","first-page":"4639","DOI":"10.1182\/blood-2010-04-281717","article-title":"Improved regulatory T-cell activity in patients with chronic immune thrombocytopenia treated with thrombopoietic agents","volume":"116","author":"Bao","year":"2010","journal-title":"Blood"},{"issue":"11","key":"2019111704221337300_B35","doi-asserted-by":"crossref","first-page":"2807","DOI":"10.1111\/trf.12139","article-title":"Sustained remissions of immune thrombocytopenia associated with the use of thrombopoietin receptor agonists","volume":"53","author":"Ghadaki","year":"2013","journal-title":"Transfusion"},{"issue":"2","key":"2019111704221337300_B36","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1111\/bjh.13827","article-title":"Remission and platelet responses with romiplostim in primary immune thrombocytopenia: final results from a phase 2 study","volume":"172","author":"Newland","year":"2016","journal-title":"Br J Haematol"},{"issue":"25","key":"2019111704221337300_B37","doi-asserted-by":"crossref","first-page":"3906","DOI":"10.1182\/blood-2014-01-549360","article-title":"Eltrombopag and high-dose dexamethasone as frontline treatment of newly diagnosed immune thrombocytopenia in adults","volume":"123","author":"G\u00f3mez-Almaguer","year":"2014","journal-title":"Blood"},{"issue":"12","key":"2019111704221337300_B38","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.medcli.2015.03.014","article-title":"Risk of thromboembolism with thrombopoietin receptor agonists in adult patients with thrombocytopenia: systematic review and meta-analysis of randomized controlled trials","volume":"145","author":"Catal\u00e1-L\u00f3pez","year":"2015","journal-title":"Med Clin (Barc)"},{"issue":"3","key":"2019111704221337300_B39","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/s12185-015-1837-6","article-title":"Integrated analysis of long-term safety in patients with chronic immune thrombocytopaenia (ITP) treated with the thrombopoietin (TPO) receptor agonist romiplostim","volume":"102","author":"Cines","year":"2015","journal-title":"Int J Hematol"},{"issue":"7","key":"2019111704221337300_B40","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1002\/ajh.24011","article-title":"Evaluation of bone marrow reticulin in patients with chronic immune thrombocytopenia treated with eltrombopag: data from the EXTEND study","volume":"90","author":"Brynes","year":"2015","journal-title":"Am J Hematol"},{"issue":"22","key":"2019111704221337300_B41","doi-asserted-by":"crossref","first-page":"3295","DOI":"10.1182\/blood-2014-04-570127","article-title":"Clinical and laboratory predictors of chronic immune thrombocytopenia in children: a systematic review and meta-analysis","volume":"124","author":"Heitink-Poll\u00e9","year":"2014","journal-title":"Blood"},{"issue":"22","key":"2019111704221337300_B42","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1182\/blood.V128.22.866.866","article-title":"Treatment with intravenous immunoglobulin does not prevent chronic immune thrombocytopenia in children: results of a randomized controlled trial","volume":"128","author":"Heitink-Polle","year":"2016","journal-title":"Blood"},{"issue":"3","key":"2019111704221337300_B43","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1182\/blood-2015-07-659656","article-title":"High-dose dexamethasone vs prednisone for treatment of adult immune thrombocytopenia: a prospective multicenter randomized trial","volume":"127","author":"Wei","year":"2016","journal-title":"Blood"},{"issue":"21","key":"2019111704221337300_B44","doi-asserted-by":"crossref","first-page":"3687","DOI":"10.1182\/blood.V116.21.3687.3687","article-title":"High dose dexamethasone vs. conventional dose prednisolone for adults with immune thrombocytopenia: a prospective multicenter phase III trial","volume":"116","author":"Bae","year":"2010","journal-title":"Blood"},{"issue":"1","key":"2019111704221337300_B45","doi-asserted-by":"crossref","first-page":"2124","DOI":"10.1159\/000362529","article-title":"Long-term effect of high-dose dexamethasone with or without low-dose dexamethasone maintenance in untreated immune thrombocytopenia","volume":"133","author":"Din","year":"2015","journal-title":"Acta Haematol"},{"issue":"1","key":"2019111704221337300_B46","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/2008-2231-20-7","article-title":"Single course of high dose dexamethasone is more effective than conventional prednisolone therapy in the treatment of primary newly diagnosed immune thrombocytopenia","volume":"20","author":"Mashhadi","year":"2012","journal-title":"Daru"}],"updated-by":[{"DOI":"10.1182\/asheducation-2018.1.584","type":"erratum","label":"Erratum","source":"publisher","updated":{"date-parts":[[2018,11,30]],"date-time":"2018-11-30T00:00:00Z","timestamp":1543536000000}}],"container-title":["Hematology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/ashpublications.org\/hematology\/article-pdf\/2017\/1\/400\/1249434\/hem00055.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/ashpublications.org\/hematology\/article-pdf\/2017\/1\/400\/1249434\/hem00055.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,11,17]],"date-time":"2019-11-17T09:22:27Z","timestamp":1573982547000},"score":1,"resource":{"primary":{"URL":"https:\/\/ashpublications.org\/hematology\/article\/2017\/1\/400\/21031\/Management-of-newly-diagnosed-immune"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,12,8]]},"references-count":46,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2017,12,8]]}},"URL":"https:\/\/doi.org\/10.1182\/asheducation-2017.1.400","relation":{"erratum":[{"id-type":"doi","id":"10.1182\/asheducation-2018.1.584","asserted-by":"object"}]},"ISSN":["1520-4391","1520-4383"],"issn-type":[{"value":"1520-4391","type":"print"},{"value":"1520-4383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12,8]]}}}