1. ITP: The Past Decade 2006-2015 Ming Hou Qilu Hospital, Shandong University

2. Nomenclature Idiopathic Thrombocytopenic Purpura (ITP) Immune Thrombocytopenia (ITP) 2007 International ITP working group. Blood. 2009, 113(11):2386-93.

3. Phases of ITP International ITP working group. Blood. 2009, 113(11):2386-93. 0 6 Months Chronic ITP Acute ITP 2007 0 3 Months 12 Months Newly ITPPersistent ITPChronic ITP

4. USA UK Japan Epidemiology and incidence of ITP France Danmark

5. Pathogenesis of ITP Decreased production Increased destruction Humoral immunity Cell immunity Spleen RES Liver Desialya tion CTL lysis Liver Desialya tion J Immunol. 2015 Jun 15;194(12):5579-5587. Br J Haematol. 2014 Apr;165(2):248-58 Loss of Immune tolerance Dysmegakaryocyt opoiesis Differe ntiation Aapop tosis

6. Loss of T cell tolerance Anergy T cell Tregs Apoptotic T cell Th1/Th2

7. T cell-mediated cytotoxicity

8. Dysmegakaryocytopoiesis

9. Desialyation Hepatocytes PLT Platelet desialylation Qiu J, ASH Annual Meeting Abstracts, 2014 Ni H, Nat Communication, 2015

10. Laboratory Diagnosis of ITP MAIPA/Flow Cytometric Immunobead Assay immune vs non-immune TPO concentration assay ITP vs atypical AA or MDS Curr Hematol Rep. 2005 Mar;4(2):160-5. Br J Haematol. 2009 Sep;146(6):585-96. Eur J Haematol. 2011 Apr;86(4):339-46. Br J Haematol. 1998 Jun;101(3):420-4.

11. Treatment not indicated platelet > 30×10 9 /L no bleeding symptom no increased risk of bleeding International ITP working group. Blood. 2009, 113(11):2386-93. ITP therapy

12. Conventional PDN HD-DXM International ITP working group. Blood. 2009, 113(11):2386-93. First-line treatment short-term application

13. Conventional PDN vs HD-DXM One or two courses of HD-DXM demonstrated higher CR rate, shorter time to response and less adverse events than PDN. Wei Y, et al, Conventional Oral Prednisone Versus High-Dose Dexamethasone for Management of Adult Immune Thrombocytopenia: A Prospective Randomized Multicenter Clinical Trial, 2014 ASH abstract, 1455 NCT01356511

14. Thrombopoiesis stimulating agents rhTPO Romiplostim Eltrombopag short TTR low sustained response rate N Engl J Med. 2007; 357(22):2237-47. Lancet. 2008;371(9610):395-403. Lancet. 2009;373(9664):641-8. N Engl J Med. 2010;363(20):1889-99. Int J Hematol. 2012;96(2):222-8. Blood. 2015;125(10):1541-7. Second-line treatment - 1

15. Rituximab long TTR high sustained response rate Blood. 2001;98(4):952-7. Ann Intern Med. 2007;146(1):25-33. Haematologica. 2008; 93(6):930-3. Blood. 2012;119(25):5989-95. Blood. 2015;125(10):1541-7. Lancet. 2015;385(9978):1653-61. Second-line treatment - 2

16. Splenectomy 32% sustained response surgical risk post-splenectomy state Blood. 2004;104(9):2623-34. Blood. 2013;121(23):4782-90. Second-line treatment - 3

17. DXM plus Rituximab DXM plus Eltrombopag rhTPO plus Rituximab DXM, Rituximab and Cyclosporin Blood. 2015;125(10):1541-7. Blood. 2010;115(14):2755-62. David GA. ASH Annual Meeting Abstracts, 2013 Blood. 2015 May 13. Epub ahead of print Combined therapy

18. Definition of response CR: platelet count > 100×10 9 /L and absence of bleeding R: platelet count > 30×10 9 /L and at least 2-fold increase the baseline count and absence of bleeding NR: platelet count < 30×10 9 /L or less than 2-fold increase of baseline

19. ITP: The Next Decade Restoration of immune tolerance Tregs/Bregs BAFF/BAFF-R antagonist MSC/Thalidomide MDSC DANA/Oseltamivir Anti-inflammatory macrophages/dasatinib

20. Thank you