Fatigue in children and adolescents with immune thrombocytopenia |
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| Authors: | Rachael F. Grace Robert J. Klaassen Kristin A. Shimano Michele P. Lambert Amanda Grimes James B. Bussel Vicky R. Breakey Yves D. Pastore Vandy Black Kathleen Overholt Rukhmi Bhat Peter W. Forbes Cindy Neunert |
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| Affiliation: | 1. Dana-Farber/Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA;2. Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada;3. Division of Allergy/Immunology/Bone Marrow Transplant, UCSF Benioff Children's Hospital, San Francisco, CA, USA;4. Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA;5. Baylor College of Medicine, Texas Children's Cancer and Hematology Center, Houston, TX, USA;6. Weill Cornell Medicine, New York, NY, USA;7. McMaster University, Hamilton, ON, Canada;8. CHU Sainte-Justine, Montreal, QC, Canada;9. Division of Pediatric Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL, USA;10. Riley Hospital at IU Health, Indiana University School of Medicine, Indianapolis, IN, USA;11. Ann and Robert H. Lurie Childrens Hospital of Chicago, Chicago, IL, USA;12. Clinical Research Center, Boston Children's Hospital, Boston, MA, USA;13. Columbia University Medical School, New York, NY, USA |
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| Abstract: | Immune thrombocytopenia (ITP), an acquired autoimmune disorder of low platelets and risk of bleeding, has a substantial impact on health-related quality of life (HRQoL). Patients with ITP often report significant fatigue, although the pathophysiology of this is poorly understood. In this observational cohort of 120 children receiving second-line therapies for ITP, we assessed reports of fatigue using the Hockenberry Fatigue Scale. Children and adolescents with ITP reported a similarly high level of fatigue with 54% (29/54) of children and 62% (26/42) of adolescents reporting moderate-to-severe fatigue. There was no correlation between fatigue and age or gender. Adolescents with newly diagnosed and persistent ITP had higher mean fatigue scores than those with chronic ITP (P = 0·03). Fatigue significantly improved in children and adolescents by 1 month after starting second-line treatments, and this improvement continued to be present at 12 months after starting treatment. Fatigue scores at all time-points correlated with general HRQoL using the Kids ITP Tool, but did not correlate with bleeding symptoms, platelet count, or platelet response to treatment. Fatigue is common in children and adolescents with ITP and may benefit from ITP-directed treatment even in the absence of bleeding symptoms. |
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| Keywords: | fatigue immune thrombocytopenia rituximab thrombopoietin receptor agonists quality of life |
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