Analysis Of Clinical Characteristics And Contributions Of T Lymphocyte Abnormalities To Therapeutic Outcomes In Elderly Patients With Immune Thrombocytopenia

Part ? Analysis of clinical characteristics in elderly patients with immune thrombocytopeniaObjective:To describe the clinical characteristics and assess the therapeutic responses and side effects of elderly patients with immune thrombocytopenia(ITP).Methods:We retrospectively reviewed 170 elderly patients(aged over 60 years old)who were diagnosed with ITP during the period from January 2005 to December 2015 in the hematology department of Wuxi People's Hospital.We analysed their age,gender,bleeding symptoms,platelet count at diagnose,comorbidities,treatments,response rates,side effects and mortality.Results:(1)The age range of these 170 cases was 60 to 92 years old and the media age was 69.7 years.The ratio of males to females was 0.75:1.(2)157 cases(92.4%)had bleeding symptoms at time of disease onset with a media bleeding score of 7.7.13 patients(7.6%)were asymptomatic.The mean platelet count was 13.1×109/L in symptomatic patients and respectively 26.0×109/L in asymptomatic patients.There was a negative correlation between bleeding score and platelet count(r=-0.26,P=0.0005).67 patients(39.4%)presented with the bleeding score>8.Among them,43.8%of males had frank bleeding manifestations compared with 36.1%of females.There was no obvious evidence that males were more likely to present with severe bleeding symptoms than females(P=0.3432).(3)112 cases(65.9%)had various comorbidities mainly including hypertension,diabetes,chronic obstructive pulmonary disease(COPD),cerebral infarction,coronary heart disease(CHD),infection,etc.(4)The near response rate was:87.3%(55/63)with corticosteroids,50.0%(1/2)with intravenous immunoglobulin(IVIG),85.1%(86/101)with corticosteroids combined with IVIG.59 patients(34.7%)received second-line therapies because they failed or relapsed after first-line treatment.Among them,57.1%(4/7)with danazol,65.5%(19/29)with immunosuppressant drugs,78.9%(15/19)with recombinant human IL-11(rhIL-11),92.3%(12/13)with recombinant human thrombopoietin(rhTPO),50.0%(1/2)with rituximab and 50.0%(5/10)with combination chemotherapies achieved remission.Most patients had light side effects after using corticosteroids,mainly presented with controllable hypertension,hyperglycemia and infections.Only one patient died of septic shock and multiple organ failure during our follow-up.Conclusions:This study suggests that ITP in elderly patients usually present with severe bleeding symptoms and various comorbidities.Most elderly patients showed fine response rate and tolerance to corticosteroids therapy.Treatment strategy should be individualized to each elderly patients.Part ? Contributions of T lymphocyte abnormalities to therapeutic outcomes in elderly patients with immune thrombocytopeniaObjective:To explore the clinical significance of T lymphocyte subsets and immunoglobulin G(IgG)levels in the peripheral blood in elderly patients with newly diagnosed ITP before and after first-line treatment.Methods:35 elderly ITP patients were treated with intravenous immunoglobulin(IVIG)plus corticosteroids and therapeutic responses were evaluated.T lymphocyte subsets including CD2+,CD3+,CD4+,CD8+,CD19+,NK cell expression and the ratio of CD4+/CD8+in the peripheral blood of 35 newly diagnosed 1TP patients and 30 normal controls were detected by flow cytometry.IgG levels in peripheral serum were determined by enzyme-linked immuno sorbent assay(ELISA).Results:Compared with the control group,we observed increased IgG and CD 19+cell expression and decreased CD4+/CD8+cell ratio in ITP group before treatment.According to treatment responses,ITP patients were divided into respond and non-respond groups.After treatment,the increased IgG and CD 19+ cell expression could be reduced in both respond and non-respond groups,while CD4+,CD8+ cell percentage and CD4+/CD8+cell ratio could not be corrected in non-respond ITP patients.Furthermore,even lower NK cell expression was found in non-respond elderly patients after treatment when compared with that in controls.Conclusion:Our research suggested that elderly ITP patients with abnormal T lymphocyte subsets were less likely to response to first-line treatment.Higher levels of CD8+ cells and lower levels of CD4+ cells,CD4+/CD8+ cell ratio and NK cells made therapies more difficult.Therefore,different therapies towards different mechanisms are needed in these patients.