PO089 | A RISK-ADAPTED, MULTIDISCIPLINARY CONSENSUS FOR ADULT ITP MANAGEMENT: BRIDGING GUIDELINES AND REAL-WORLD PRACTICE

A. Votto¹, E. Pacini², G. Giustini³, I. Rina¹, S. Galimberti¹ | ¹Department of Clinical and Experimental Medicine, University of Pisa, Italy; ²Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Italy; ³Hematology Unit, AOU Careggi, Firenze, Italy

Background and Aims. Immune thrombocytopenia (ITP) is a rare and heterogeneous immune-mediated disorder characterized by unpredictable bleeding risk, paradoxical thrombotic complications, and significant treatment-related burden. Despite the availability of multiple therapeutic options, real-world management remains highly variable, and optimal sequencing of therapies is still debated. We aimed to develop a multidisciplinary, real-world regional consensus to standardize the management of adult ITP and address current unmet clinical needs.
Methods. A structured narrative review of international guidelines and recent evidence was integrated with real-world clinical experience. Multidisciplinary meetings involving 25 experts from the three Tuscan university centers and affiliated hospital networks were conducted to define key clinical statements. Core domains included diagnosis, treatment thresholds, therapeutic sequencing, management of refractory disease, and patient-centered outcomes. Consensus was reached with a level of agreement >90% for all recommendations, with a focus on lo safety-driven and individualized care.
Results. The consensus highlights persistent unmet needs in ITP, including variability in treatment initiation, risk of overtreatment, and lack of standardized sequencing beyond first-line therapy. A risk-adapted strategy was proposed: observation for asymptomatic patients with platelet counts >30×10^9/L; early treatment for <30×10^9/L and/or bleeding; and individualized decisions in intermediate-risk scenarios. Short-course corticosteroids remain first-line therapy, with IVIg reserved for urgent indications. TPO-RAs are identified as the preferred second-line option due to high response rates (~70–90%) and sustained efficacy, while fostamatinib represents a key alternative in patients with high thrombotic risk. Rituximab is reserved for selected cases requiring treatment-free intervals. Splenectomy is deferred and restricted to highly selected patients. The consensus also emphasizes the emerging role of novel agents (FcRn inhibitors, BTK inhibitors, and B-cell targeted therapies) and combination strategies in refractory disease, as well as the critical impact of fatigue, psychological burden, and long-term treatment exposure on quality of life.
Conclusions. This regional consensus provides a pragmatic, safety-oriented, and future-focused framework for ITP management, integrating current evidence with real-world practice. A high-agreement multidisciplinary approach may reduce variability, optimize treatment sequencing, and better address unmet needs, supporting a shift toward personalized and standard care in ITP.