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Case Reports in Hematology
Volume 2017 (2017), Article ID 4109605, 8 pages
https://doi.org/10.1155/2017/4109605
Case Report

Sustained Remission in Patients with Primary Immune Thrombocytopenia after Romiplostim Tapering and Discontinuation: A Case Series in Real Life Management in Spain

1Hematology Department, Hospital Regional Universitario de Málaga, Av. de Carlos Haya, s/n, 29010 Málaga, Spain
2Hematology Department, Hospital Universitario 12 de Octubre, Avda. Córdoba, s/n, 28041 Madrid, Spain
3Hematology Department, Hospital Universitari Vall d’Hebron, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
4Amgen S.A., Moll de Barcelona, Edifici Sud, Planta 7, 08039 Barcelona, Spain

Correspondence should be addressed to María-Eva Mingot-Castellano; moc.liamg@tognimem

Received 25 April 2017; Accepted 16 May 2017; Published 11 June 2017

Academic Editor: Masayuki Nagasawa

Copyright © 2017 María-Eva Mingot-Castellano et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Romiplostim, a thrombopoietin-receptor agonist (TPO-ra), is a highly effective option in primary immune thrombocytopenia (ITP), with 80–90% of patients achieving platelet responses after few weeks of treatment. The evidence showing remissions, that is, sustained platelet counts after romiplostim discontinuation, in patients with ITP refractory to immunosuppressive therapy is steadily increasing. However, there is a lack of guidelines or recommendations addressing how and when to taper romiplostim in clinical practice in patients maintaining elevated and stable platelet counts. Furthermore, given the high heterogeneity of ITP patients, no associated predictive factors have been currently identified. Here, we present 4 representative clinical cases of the daily clinical practice in Spain comprising newly diagnosed, persistent, and both splenectomized and nonsplenectomized chronic ITP patients treated with romiplostim, achieving and maintaining clinical remission (platelet count ≥ 50 109/L for 24 consecutive weeks in the absence of any treatment for ITP) after treatment tapering and discontinuation, without observed safety concerns. Prospective studies identifying clinical and biological predictive factors of sustained response are warranted.