Fibroproliferative activity in patients with immune thrombocytopenia (ITP) treated with thrombopoietic agents Academic Article uri icon


MeSH Major

  • Benzoates
  • Bone Marrow
  • Hepatocyte Growth Factor
  • Hydrazines
  • Peptide Fragments
  • Primary Myelofibrosis
  • Procollagen
  • Purpura, Thrombocytopenic, Idiopathic
  • Pyrazoles
  • Receptors, Thrombopoietin
  • Recombinant Fusion Proteins
  • Reticulin
  • Thrombopoietin


  • This study assessed the grade of bone marrow (BM) fibrosis and its association with a seromarker for collagen-III formation and fibrosis-related cytokines in 25 immune thrombocytopenia (ITP) patients treated with thrombopoietin receptor agonists (Tpo-RA) who had at least one BM biopsy. Assessment of 8 pre- and on-treatment BM biopsies revealed statistically significant increases in reticulin. Reticulin in biopsies performed after a median of 1·4 years of treatment was graded: MF-0 in 3 (12%), MF-1 in 19 (76%), MF-2 in 2 (8%) and MF-3 in 1 (4%). No cytogenetic or flow-cytometric abnormalities were detected. Median pretreatment Procollagen III N-propeptide (PIIINP) (6·6 μg/l) was significantly higher than on-treatment levels (5·6 μg/l); both were higher than controls (3·4 μg/l; P < 0·001). PIIINP was negatively correlated with treatment duration (r = -0·49) suggesting a decelerated reticulin production over time. There was a trend towards an association between grade of reticulin and PIIINP. Transforming growth factor (GF)-beta and basic-Fibroblast GF were not different between patients and controls but Hepatocyte GF (HGF), an anti-fibrotic cytokine, was significantly elevated in patients. In conclusion, low-grade BM reticulin fibrosis is seen in most ITP patients on Tpo-RA. The novel findings of decreasing PIIINP and elevated HGF need further investigation to explore their significance in BM fibrogenesis.

publication date

  • October 2011



  • Academic Article



  • eng

Digital Object Identifier (DOI)

  • 10.1111/j.1365-2141.2011.08845.x

PubMed ID

  • 21902682

Additional Document Info

start page

  • 248

end page

  • 55


  • 155


  • 2