A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience

Objective: The aim of the present study was to evaluate the efficacyand safety of eltrombopag, an oral thrombopoietin receptor agonist,in patients with chronic immune thrombocytopenia (ITP).Materials and Methods: A total of 285 chronic ITP patients (187women, 65.6%; 98 men, 34.4%) followed in 55 centers were enrolledin this retrospective cohort. Response to treatment was assessedaccording to platelet count (/mm3) and defined as complete (plateletcount of >100,000/mm3), partial (30,000-100,000/mm3 or doublingof platelet count after treatment), or unresponsive (<30,000/mm3).Clinical findings, descriptive features, response to treatment, and sideeffects were recorded. Correlations between descriptive, clinical, andhematological parameters were analyzed.Results: The median age at diagnosis was 43.9±20.6 (range: 3-95)years and the duration of follow-up was 18.0±6.4 (range: 6-28.2)months. Overall response rate was 86.7% (n=247). Complete andpartial responses were observed in 182 (63.8%) and 65 (22.8%)patients, respectively. Thirty-eight patients (13.4%) did not respondto eltrombopag treatment. For patients above 60 years old (n=68),overall response rate was 89.7% (n=61), and for those above 80 years old (n=12), overall response rate was 83% (n=10). Consideringthrombocyte count before treatment, eltrombopag significantlyincreased platelet count at the 1st, 2nd, 3rd, 4th, and 8th weeks oftreatment. As the time required for partial or complete responseincreased, response to treatment was significantly reduced. The timeto reach the maximum platelet levels after treatment was quitevariable (1-202 weeks). Notably, the higher the maximum plateletcount after eltrombopag treatment, the more likely that side effectswould occur. The most common side effects were headache (21.6%),weakness (13.7%), hepatotoxicity (11.8%), and thrombosis (5.9%).Conclusion: Results of the current study imply that eltrombopag isan effective therapeutic option even in elderly patients with chronicITP. However, patients must be closely monitored for response andside effects during treatment. Since both response and side effectsmay be variable throughout the follow-up period, patients should beevaluated dynamically, especially in terms of thrombotic risk factors.

Anahtar Kelime:

Refrakter Kronik İmmün Trombositopeni Tedavisinde Eltrombopagın Etkinliğine İlişkin Çok Merkezli Bir Çalışma: Gerçek Yaşam Deneyimi

Öz:

Amaç: Bu çalışmanın amacı kronik immün trombositopeni (ITP) hastalarında bir oral trombopoietin reseptör agonisti olan eltrombopagın etkinlik ve güvenirliliğini değerlendirmektir. Gereç ve Yöntemler: Elli beş merkezde izlem altındaki toplam 285 kronik ITP hastası (187 kadın, %65,6) bu geriye dönük küme çalışmasına alınmıştır. Tedaviye yanıt trombosit sayısına göre değerlendirilmiş ve tam yanıt (>100.000/mm3), kısmi yanıt (30.000-100.000/mm3 veya tedaviden sonra trombosit sayısının bir kat artmış olması) ve yanıtsızlık (<30.000/mm3) olarak tanımlanmıştır. Hastaların klinik bulguları, tanımlayıcı özellikleri, tedaviye yanıt ve yan etki bilgileri toplanmış ve aralarındaki ilişki incelenmiştir. Bulgular: Tanı anında yaş ortalaması 43,9±20,6 (3-95) yıl olan hastalar ortalama 18,0±6,4 (6-28,2) ay izlenmiştir. Tam ve kısmi yanıtı içeren toplam yanıt %86,7 (n=247) bulundu. Sırasıyla 182 (%63,8) ve 65 (%22,8) hastada tam ve parsiyel tedavi yanıtları gözlenmiştir. Otuz sekiz hasta (%13,4) eltrombopag tedavisine yanıt vermemiştir. Altmış yaş üzerindeki hastalarda (n=68) toplam yanıt %89,7 (n=61) bulunurken, bu oran 80 yaş üzerindeki (n=12) hastalarda %83 (n=10) olmuştur. Tedavi öncesi trombosit sayısı göz önüne alındığında, eltrombopag,tedavinin 1., 2., 3., 4. ve 8. haftalarında trombosit sayısını anlamlı şekilde artırmıştır. Kısmi veya tam cevap için gereken süre arttıkça, tedaviye cevap önemli ölçüde azaldığı saptanmıştır. Eltrombopag tedavisinden sonra maksimum trombosit sayısı ne kadar yüksekse, yan etkilerin oluşabilme ihtimalinin o kadar yüksek olabildiği dikkati çekmiştir. En sık görülen yan etkiler baş ağrısı (%21,6), güçsüzlük (%13,7) ve hepatotoksisite (%11,8) ve trombozdur (%5,9). Sonuç: Mevcut çalışmanın sonuçları, eltrombopag tedavisinin kronik ITP’de, yaşlı hastalar dahil olmak üzere, etkili bir tedavi seçeneği olduğunu göstermektedir. Bununla birlikte, hastalar tedavi sırasında yanıt ve yan etkiler açısından yakından izlenmelidir. Hem cevap hem de yan etkiler, takip süresi boyunca değişken olabileceğinden, hastalar özellikle tromboz risk faktörleri açısından dinamik olarak değerlendirilmelidir.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Kühne T, Imbach P. Eltrombopag: an update on the novel, nonpeptide thrombopoietin receptor agonist for the treatment of immune thrombocytopenia. Ann Hematol 2010;89(Suppl 1):67-74.
2. Chang M, Nakagawa PA, Williams SA, Schwartz MR, Imfeld KL, Buzby JS, Nugent DJ. Immune thrombocytopenic purpura (ITP) plasma and purified ITP monoclonal autoantibodies inhibit megakaryocytopoiesis in vitro. Blood 2003;102:887-895.
3. Cooper N, Bussel J. The pathogenesis of immune thrombocytopaenic purpura. Br J Haematol 2006;133:364-374.
4. Neylon AJ, Saunders PW, Howard MR, Proctor SJ, Taylor PR. Clinically significant newly presenting autoimmune thrombocytopenic purpura in adults: a prospective study of a population-based cohort of 245 patients. Br J Haematol 2003;122:966-974.
5. Stasi R, Provan D. Management of immune thrombocytopenic purpura in adults. Mayo Clin Proc 2004;79:504-522.
6. Cines D, Bussel J. How I treat idiopathic thrombocytopenic purpura (ITP). Blood 2005;106:2244-2251.
7. Çekdemir D, Diz Küçükkaya R. Treatment and prognosis of immune thrombocytopenia. Turkiye Klinikleri J Hematol-Special Topics 2014;7:72- 79.
8. Cheng G, Saleh MN, Marcher C, Vasey S, Mayer B, Aivado M, Arning M, Stone NL, Bussel JB. Eltrombopag for management of chronic immune thrombocytopenia (RAISE): a 6-month, randomised, phase 3 study. Lancet 2011;377:393-402.
9. Grainger JD, Locatelli F, Chotsampancharoen T, Donyush E, Pongtanakul B, Komvilaisak P, Sosothikul D, Drelichman G, Sirachainan N, Holzhauer S, Lebedev V, Lemons R, Pospisilova D, Ramenghi U, Bussel JB, Bakshi KK, Iyengar M, Chan GW, Chagin KD, Theodore D, Marcello LM, Bailey CK. Eltrombopag for children with chronic immune thrombocytopenia (PETIT2): a randomised, multicentre, placebo-controlled trial. Lancet 2015;386:1649-1658.
10. Erickson-Miller CL, DeLorme E, Tian SS, Hopson CB, Stark K, Giampa L, Valoret EI, Duffy KJ, Luengo JL, Rosen J, Miller SG, Dillon SB, Lamb P. Discovery and characterization of a selective, nonpeptidyl thrombopoietin receptor agonist. Exp Hematol 2005;33:85-93.
11. Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, Chong BH, Cines DB, Gernsheimer TB, Godeau B, Grainger J, Greer I, Hunt BJ, Imbach PA, Lyons G, McMillan R, Rodeghiero F, Sanz MA, Tarantino M, Watson S, Young J, Kuter DJ. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010;115:168-186.
12. Chouhan JD, Herrington JD. Treatment options for chronic refractory idiopathic thrombocytopenic purpura in adults: focus on romiplostim and eltrombopag. Pharmacotherapy 2010;30:666-683.
13. González-López TJ, Fernández-Fuertes F, Hernández-Rivas JA, SánchezGonzález B, Martínez-Robles V, Alvarez-Román MT, Pérez-Rus G, Pascual C, Bernat S, Arrieta-Cerdán E, Aguilar C, Bárez A, Peñarrubia MJ, Olivera P, Fernández-Rodríguez A, de Cabo E, García-Frade LJ, González-Porras JR. Efficacy and safety of eltrombopag in persistent and newly diagnosed ITP in clinical practice. Int J Hematol 2017;106:508-516.
14. Mazza P, Minoia C, Melpignano A, Polimeno G, Cascavilla N, Di Renzo N, Specchia G. The use of thrombopoietin-receptor agonists (TPO-RAs) in immune thrombocytopenia (ITP): a “real life” retrospective multicenter experience of the Rete Ematologica Pugliese (REP). Ann Hematol 2017;95:239-244.
15. Wong RSM, Saleh MN, Khelif A, Salama A, Portella MSO, Burgess P, Bussel JB. Safety and efficacy of long-term treatment of chronic/persistent ITP with eltrombopag: final results of the EXTEND study. Blood 2017;130:2527- 2536.
16. Garnock-Jones KP. Eltrombopag: a review of its use in treatment-refractory chronic primary immune thrombocytopenia. Drugs 2011;71:1333-1353.
17. Saleh MN, Bussel JB, Cheng G, Meyer O, Bailey CK, Arning M, Brainsky A; EXTEND Study Group. Safety and efficacy of eltrombopag for treatment of chronic immune thrombocytopenia: results of the long-term, open-label EXTEND study. Blood 2013;121:537-545.

APA	ÇEKDEMIR D, Güvenç S, Gediz F, Eser A, Toptas T, Ozkocaman V, Haydaroglu Sahin H, Ermis Turak E, esen r, Cömert M, SADRİ S, ASLANER AK M, Uncu Ulu B, KARAKUS A, Selim Batur D, ALACACIOGLU I, aydın d, Tekinalp A, NAMDAROGLU S, ceran f, Tarkun P, Kiper Unal H, Cetiner M, Yenerel M, Demir A, YILMAZ G, Terzi H, Atilla E, Malkan U, Acar K, Öztürk E, TOMBAK A, Sunu C, salim o, Alayvaz Aslan N, SAYAN S, OZAN O, Ayer M, Gokgoz Z, Andic N, kızılkılıç e, Figen F, Özen M, Pepedil Tanrikulu F, alanoglu g, Ozkan H, aslan v, Çetin G, akyol a, deveci B, Ersoy Dursun F, Dermenci H, Aytan P, Gunduz M, karakuş v, özlü c, Demircioğlu S, akay o, ÖZATLI D, Undar L, Tiftik E, Türköz Sucak G, Haznedaroglu I, Ozcan M, SENCAN M, Tombuloglu M, ozet g, Bilgir O, Turgut B, OZCAN M, Payzın B, Sonmez M, AYYILDIZ M, DAL M, ERTOP S, TURGUT M, Soysal T, Kaya E, ÜNAL A, PEHLİVAN M, ATAGÜNDÜZ I, Fıratlı Tuğlular T, Saydam G, Diz-Kucukkaya R (2019). A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience. , 230 - 237. 10.4274/tjh.galenos.2019.2018.0307
Chicago	ÇEKDEMIR DEMET,Güvenç Serkan,Gediz Fusun,Eser Ali,Toptas Tayfur,Ozkocaman Vildan,Haydaroglu Sahin Handan,Ermis Turak Esra,esen ramazan,Cömert Melda,SADRİ Sevil,ASLANER AK Müzeyyen,Uncu Ulu Bahar,KARAKUS ABDULLAH,Selim Batur Derya,ALACACIOGLU INCI,aydın demet,Tekinalp Atakan,NAMDAROGLU SİNEM,ceran funda,Tarkun Pinar,Kiper Unal Hatice Demet,Cetiner Mustafa,Yenerel Mustafa Nuri,Demir Ahmet Muzaffer,YILMAZ GÜVEN,Terzi Hatice,Atilla Erden,Malkan Umit Yavuz,Acar Kadir,Öztürk Erman,TOMBAK ANIL,Sunu Cenk,salim ozan,Alayvaz Aslan Nevin,SAYAN Sayan,OZAN Ozan,Ayer Mesut,Gokgoz Zafer,Andic Neslıhan,kızılkılıç ebru,Figen Figen,Özen Mehmet,Pepedil Tanrikulu Funda,alanoglu guchan,Ozkan Hasan Atilla,aslan vahap,Çetin Güven,akyol alev,deveci BURAK,Ersoy Dursun Fadime,Dermenci Hasan,Aytan Pelin,Gunduz Mehmet,karakuş volkan,özlü can,Demircioğlu Sinan,akay olga meltem,ÖZATLI Düzgün,Undar Levent,Tiftik Eyüp Naci,Türköz Sucak Gülsan,Haznedaroglu Ibrahim C.,Ozcan Muhit,SENCAN MEHMET,Tombuloglu Murat,ozet gulsum,Bilgir Oktay,Turgut Burhan,OZCAN MEHMET ALI,Payzın Bahriye,Sonmez Mehmet,AYYILDIZ MEHMET ORHAN,DAL MEHMET SINAN,ERTOP SEHMUS,TURGUT Mehmet,Soysal Teoman,Kaya Emin,ÜNAL Ali,PEHLİVAN MUSTAFA,ATAGÜNDÜZ ISIK,Fıratlı Tuğlular Tülin,Saydam Guray,Diz-Kucukkaya Reyhan A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience. (2019): 230 - 237. 10.4274/tjh.galenos.2019.2018.0307
MLA	ÇEKDEMIR DEMET,Güvenç Serkan,Gediz Fusun,Eser Ali,Toptas Tayfur,Ozkocaman Vildan,Haydaroglu Sahin Handan,Ermis Turak Esra,esen ramazan,Cömert Melda,SADRİ Sevil,ASLANER AK Müzeyyen,Uncu Ulu Bahar,KARAKUS ABDULLAH,Selim Batur Derya,ALACACIOGLU INCI,aydın demet,Tekinalp Atakan,NAMDAROGLU SİNEM,ceran funda,Tarkun Pinar,Kiper Unal Hatice Demet,Cetiner Mustafa,Yenerel Mustafa Nuri,Demir Ahmet Muzaffer,YILMAZ GÜVEN,Terzi Hatice,Atilla Erden,Malkan Umit Yavuz,Acar Kadir,Öztürk Erman,TOMBAK ANIL,Sunu Cenk,salim ozan,Alayvaz Aslan Nevin,SAYAN Sayan,OZAN Ozan,Ayer Mesut,Gokgoz Zafer,Andic Neslıhan,kızılkılıç ebru,Figen Figen,Özen Mehmet,Pepedil Tanrikulu Funda,alanoglu guchan,Ozkan Hasan Atilla,aslan vahap,Çetin Güven,akyol alev,deveci BURAK,Ersoy Dursun Fadime,Dermenci Hasan,Aytan Pelin,Gunduz Mehmet,karakuş volkan,özlü can,Demircioğlu Sinan,akay olga meltem,ÖZATLI Düzgün,Undar Levent,Tiftik Eyüp Naci,Türköz Sucak Gülsan,Haznedaroglu Ibrahim C.,Ozcan Muhit,SENCAN MEHMET,Tombuloglu Murat,ozet gulsum,Bilgir Oktay,Turgut Burhan,OZCAN MEHMET ALI,Payzın Bahriye,Sonmez Mehmet,AYYILDIZ MEHMET ORHAN,DAL MEHMET SINAN,ERTOP SEHMUS,TURGUT Mehmet,Soysal Teoman,Kaya Emin,ÜNAL Ali,PEHLİVAN MUSTAFA,ATAGÜNDÜZ ISIK,Fıratlı Tuğlular Tülin,Saydam Guray,Diz-Kucukkaya Reyhan A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience. , 2019, ss.230 - 237. 10.4274/tjh.galenos.2019.2018.0307
AMA	ÇEKDEMIR D,Güvenç S,Gediz F,Eser A,Toptas T,Ozkocaman V,Haydaroglu Sahin H,Ermis Turak E,esen r,Cömert M,SADRİ S,ASLANER AK M,Uncu Ulu B,KARAKUS A,Selim Batur D,ALACACIOGLU I,aydın d,Tekinalp A,NAMDAROGLU S,ceran f,Tarkun P,Kiper Unal H,Cetiner M,Yenerel M,Demir A,YILMAZ G,Terzi H,Atilla E,Malkan U,Acar K,Öztürk E,TOMBAK A,Sunu C,salim o,Alayvaz Aslan N,SAYAN S,OZAN O,Ayer M,Gokgoz Z,Andic N,kızılkılıç e,Figen F,Özen M,Pepedil Tanrikulu F,alanoglu g,Ozkan H,aslan v,Çetin G,akyol a,deveci B,Ersoy Dursun F,Dermenci H,Aytan P,Gunduz M,karakuş v,özlü c,Demircioğlu S,akay o,ÖZATLI D,Undar L,Tiftik E,Türköz Sucak G,Haznedaroglu I,Ozcan M,SENCAN M,Tombuloglu M,ozet g,Bilgir O,Turgut B,OZCAN M,Payzın B,Sonmez M,AYYILDIZ M,DAL M,ERTOP S,TURGUT M,Soysal T,Kaya E,ÜNAL A,PEHLİVAN M,ATAGÜNDÜZ I,Fıratlı Tuğlular T,Saydam G,Diz-Kucukkaya R A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience. . 2019; 230 - 237. 10.4274/tjh.galenos.2019.2018.0307
Vancouver	ÇEKDEMIR D,Güvenç S,Gediz F,Eser A,Toptas T,Ozkocaman V,Haydaroglu Sahin H,Ermis Turak E,esen r,Cömert M,SADRİ S,ASLANER AK M,Uncu Ulu B,KARAKUS A,Selim Batur D,ALACACIOGLU I,aydın d,Tekinalp A,NAMDAROGLU S,ceran f,Tarkun P,Kiper Unal H,Cetiner M,Yenerel M,Demir A,YILMAZ G,Terzi H,Atilla E,Malkan U,Acar K,Öztürk E,TOMBAK A,Sunu C,salim o,Alayvaz Aslan N,SAYAN S,OZAN O,Ayer M,Gokgoz Z,Andic N,kızılkılıç e,Figen F,Özen M,Pepedil Tanrikulu F,alanoglu g,Ozkan H,aslan v,Çetin G,akyol a,deveci B,Ersoy Dursun F,Dermenci H,Aytan P,Gunduz M,karakuş v,özlü c,Demircioğlu S,akay o,ÖZATLI D,Undar L,Tiftik E,Türköz Sucak G,Haznedaroglu I,Ozcan M,SENCAN M,Tombuloglu M,ozet g,Bilgir O,Turgut B,OZCAN M,Payzın B,Sonmez M,AYYILDIZ M,DAL M,ERTOP S,TURGUT M,Soysal T,Kaya E,ÜNAL A,PEHLİVAN M,ATAGÜNDÜZ I,Fıratlı Tuğlular T,Saydam G,Diz-Kucukkaya R A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience. . 2019; 230 - 237. 10.4274/tjh.galenos.2019.2018.0307
IEEE	ÇEKDEMIR D,Güvenç S,Gediz F,Eser A,Toptas T,Ozkocaman V,Haydaroglu Sahin H,Ermis Turak E,esen r,Cömert M,SADRİ S,ASLANER AK M,Uncu Ulu B,KARAKUS A,Selim Batur D,ALACACIOGLU I,aydın d,Tekinalp A,NAMDAROGLU S,ceran f,Tarkun P,Kiper Unal H,Cetiner M,Yenerel M,Demir A,YILMAZ G,Terzi H,Atilla E,Malkan U,Acar K,Öztürk E,TOMBAK A,Sunu C,salim o,Alayvaz Aslan N,SAYAN S,OZAN O,Ayer M,Gokgoz Z,Andic N,kızılkılıç e,Figen F,Özen M,Pepedil Tanrikulu F,alanoglu g,Ozkan H,aslan v,Çetin G,akyol a,deveci B,Ersoy Dursun F,Dermenci H,Aytan P,Gunduz M,karakuş v,özlü c,Demircioğlu S,akay o,ÖZATLI D,Undar L,Tiftik E,Türköz Sucak G,Haznedaroglu I,Ozcan M,SENCAN M,Tombuloglu M,ozet g,Bilgir O,Turgut B,OZCAN M,Payzın B,Sonmez M,AYYILDIZ M,DAL M,ERTOP S,TURGUT M,Soysal T,Kaya E,ÜNAL A,PEHLİVAN M,ATAGÜNDÜZ I,Fıratlı Tuğlular T,Saydam G,Diz-Kucukkaya R "A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience." , ss.230 - 237, 2019. 10.4274/tjh.galenos.2019.2018.0307
ISNAD	ÇEKDEMIR, DEMET vd. "A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience". (2019), 230-237. https://doi.org/10.4274/tjh.galenos.2019.2018.0307

APA	ÇEKDEMIR D, Güvenç S, Gediz F, Eser A, Toptas T, Ozkocaman V, Haydaroglu Sahin H, Ermis Turak E, esen r, Cömert M, SADRİ S, ASLANER AK M, Uncu Ulu B, KARAKUS A, Selim Batur D, ALACACIOGLU I, aydın d, Tekinalp A, NAMDAROGLU S, ceran f, Tarkun P, Kiper Unal H, Cetiner M, Yenerel M, Demir A, YILMAZ G, Terzi H, Atilla E, Malkan U, Acar K, Öztürk E, TOMBAK A, Sunu C, salim o, Alayvaz Aslan N, SAYAN S, OZAN O, Ayer M, Gokgoz Z, Andic N, kızılkılıç e, Figen F, Özen M, Pepedil Tanrikulu F, alanoglu g, Ozkan H, aslan v, Çetin G, akyol a, deveci B, Ersoy Dursun F, Dermenci H, Aytan P, Gunduz M, karakuş v, özlü c, Demircioğlu S, akay o, ÖZATLI D, Undar L, Tiftik E, Türköz Sucak G, Haznedaroglu I, Ozcan M, SENCAN M, Tombuloglu M, ozet g, Bilgir O, Turgut B, OZCAN M, Payzın B, Sonmez M, AYYILDIZ M, DAL M, ERTOP S, TURGUT M, Soysal T, Kaya E, ÜNAL A, PEHLİVAN M, ATAGÜNDÜZ I, Fıratlı Tuğlular T, Saydam G, Diz-Kucukkaya R (2019). A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience. Turkish Journal of Hematology, 36(4), 230 - 237. 10.4274/tjh.galenos.2019.2018.0307
Chicago	ÇEKDEMIR DEMET,Güvenç Serkan,Gediz Fusun,Eser Ali,Toptas Tayfur,Ozkocaman Vildan,Haydaroglu Sahin Handan,Ermis Turak Esra,esen ramazan,Cömert Melda,SADRİ Sevil,ASLANER AK Müzeyyen,Uncu Ulu Bahar,KARAKUS ABDULLAH,Selim Batur Derya,ALACACIOGLU INCI,aydın demet,Tekinalp Atakan,NAMDAROGLU SİNEM,ceran funda,Tarkun Pinar,Kiper Unal Hatice Demet,Cetiner Mustafa,Yenerel Mustafa Nuri,Demir Ahmet Muzaffer,YILMAZ GÜVEN,Terzi Hatice,Atilla Erden,Malkan Umit Yavuz,Acar Kadir,Öztürk Erman,TOMBAK ANIL,Sunu Cenk,salim ozan,Alayvaz Aslan Nevin,SAYAN Sayan,OZAN Ozan,Ayer Mesut,Gokgoz Zafer,Andic Neslıhan,kızılkılıç ebru,Figen Figen,Özen Mehmet,Pepedil Tanrikulu Funda,alanoglu guchan,Ozkan Hasan Atilla,aslan vahap,Çetin Güven,akyol alev,deveci BURAK,Ersoy Dursun Fadime,Dermenci Hasan,Aytan Pelin,Gunduz Mehmet,karakuş volkan,özlü can,Demircioğlu Sinan,akay olga meltem,ÖZATLI Düzgün,Undar Levent,Tiftik Eyüp Naci,Türköz Sucak Gülsan,Haznedaroglu Ibrahim C.,Ozcan Muhit,SENCAN MEHMET,Tombuloglu Murat,ozet gulsum,Bilgir Oktay,Turgut Burhan,OZCAN MEHMET ALI,Payzın Bahriye,Sonmez Mehmet,AYYILDIZ MEHMET ORHAN,DAL MEHMET SINAN,ERTOP SEHMUS,TURGUT Mehmet,Soysal Teoman,Kaya Emin,ÜNAL Ali,PEHLİVAN MUSTAFA,ATAGÜNDÜZ ISIK,Fıratlı Tuğlular Tülin,Saydam Guray,Diz-Kucukkaya Reyhan A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience. Turkish Journal of Hematology 36, no.4 (2019): 230 - 237. 10.4274/tjh.galenos.2019.2018.0307
MLA	ÇEKDEMIR DEMET,Güvenç Serkan,Gediz Fusun,Eser Ali,Toptas Tayfur,Ozkocaman Vildan,Haydaroglu Sahin Handan,Ermis Turak Esra,esen ramazan,Cömert Melda,SADRİ Sevil,ASLANER AK Müzeyyen,Uncu Ulu Bahar,KARAKUS ABDULLAH,Selim Batur Derya,ALACACIOGLU INCI,aydın demet,Tekinalp Atakan,NAMDAROGLU SİNEM,ceran funda,Tarkun Pinar,Kiper Unal Hatice Demet,Cetiner Mustafa,Yenerel Mustafa Nuri,Demir Ahmet Muzaffer,YILMAZ GÜVEN,Terzi Hatice,Atilla Erden,Malkan Umit Yavuz,Acar Kadir,Öztürk Erman,TOMBAK ANIL,Sunu Cenk,salim ozan,Alayvaz Aslan Nevin,SAYAN Sayan,OZAN Ozan,Ayer Mesut,Gokgoz Zafer,Andic Neslıhan,kızılkılıç ebru,Figen Figen,Özen Mehmet,Pepedil Tanrikulu Funda,alanoglu guchan,Ozkan Hasan Atilla,aslan vahap,Çetin Güven,akyol alev,deveci BURAK,Ersoy Dursun Fadime,Dermenci Hasan,Aytan Pelin,Gunduz Mehmet,karakuş volkan,özlü can,Demircioğlu Sinan,akay olga meltem,ÖZATLI Düzgün,Undar Levent,Tiftik Eyüp Naci,Türköz Sucak Gülsan,Haznedaroglu Ibrahim C.,Ozcan Muhit,SENCAN MEHMET,Tombuloglu Murat,ozet gulsum,Bilgir Oktay,Turgut Burhan,OZCAN MEHMET ALI,Payzın Bahriye,Sonmez Mehmet,AYYILDIZ MEHMET ORHAN,DAL MEHMET SINAN,ERTOP SEHMUS,TURGUT Mehmet,Soysal Teoman,Kaya Emin,ÜNAL Ali,PEHLİVAN MUSTAFA,ATAGÜNDÜZ ISIK,Fıratlı Tuğlular Tülin,Saydam Guray,Diz-Kucukkaya Reyhan A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience. Turkish Journal of Hematology, vol.36, no.4, 2019, ss.230 - 237. 10.4274/tjh.galenos.2019.2018.0307
AMA	ÇEKDEMIR D,Güvenç S,Gediz F,Eser A,Toptas T,Ozkocaman V,Haydaroglu Sahin H,Ermis Turak E,esen r,Cömert M,SADRİ S,ASLANER AK M,Uncu Ulu B,KARAKUS A,Selim Batur D,ALACACIOGLU I,aydın d,Tekinalp A,NAMDAROGLU S,ceran f,Tarkun P,Kiper Unal H,Cetiner M,Yenerel M,Demir A,YILMAZ G,Terzi H,Atilla E,Malkan U,Acar K,Öztürk E,TOMBAK A,Sunu C,salim o,Alayvaz Aslan N,SAYAN S,OZAN O,Ayer M,Gokgoz Z,Andic N,kızılkılıç e,Figen F,Özen M,Pepedil Tanrikulu F,alanoglu g,Ozkan H,aslan v,Çetin G,akyol a,deveci B,Ersoy Dursun F,Dermenci H,Aytan P,Gunduz M,karakuş v,özlü c,Demircioğlu S,akay o,ÖZATLI D,Undar L,Tiftik E,Türköz Sucak G,Haznedaroglu I,Ozcan M,SENCAN M,Tombuloglu M,ozet g,Bilgir O,Turgut B,OZCAN M,Payzın B,Sonmez M,AYYILDIZ M,DAL M,ERTOP S,TURGUT M,Soysal T,Kaya E,ÜNAL A,PEHLİVAN M,ATAGÜNDÜZ I,Fıratlı Tuğlular T,Saydam G,Diz-Kucukkaya R A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience. Turkish Journal of Hematology. 2019; 36(4): 230 - 237. 10.4274/tjh.galenos.2019.2018.0307
Vancouver	ÇEKDEMIR D,Güvenç S,Gediz F,Eser A,Toptas T,Ozkocaman V,Haydaroglu Sahin H,Ermis Turak E,esen r,Cömert M,SADRİ S,ASLANER AK M,Uncu Ulu B,KARAKUS A,Selim Batur D,ALACACIOGLU I,aydın d,Tekinalp A,NAMDAROGLU S,ceran f,Tarkun P,Kiper Unal H,Cetiner M,Yenerel M,Demir A,YILMAZ G,Terzi H,Atilla E,Malkan U,Acar K,Öztürk E,TOMBAK A,Sunu C,salim o,Alayvaz Aslan N,SAYAN S,OZAN O,Ayer M,Gokgoz Z,Andic N,kızılkılıç e,Figen F,Özen M,Pepedil Tanrikulu F,alanoglu g,Ozkan H,aslan v,Çetin G,akyol a,deveci B,Ersoy Dursun F,Dermenci H,Aytan P,Gunduz M,karakuş v,özlü c,Demircioğlu S,akay o,ÖZATLI D,Undar L,Tiftik E,Türköz Sucak G,Haznedaroglu I,Ozcan M,SENCAN M,Tombuloglu M,ozet g,Bilgir O,Turgut B,OZCAN M,Payzın B,Sonmez M,AYYILDIZ M,DAL M,ERTOP S,TURGUT M,Soysal T,Kaya E,ÜNAL A,PEHLİVAN M,ATAGÜNDÜZ I,Fıratlı Tuğlular T,Saydam G,Diz-Kucukkaya R A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience. Turkish Journal of Hematology. 2019; 36(4): 230 - 237. 10.4274/tjh.galenos.2019.2018.0307
IEEE	ÇEKDEMIR D,Güvenç S,Gediz F,Eser A,Toptas T,Ozkocaman V,Haydaroglu Sahin H,Ermis Turak E,esen r,Cömert M,SADRİ S,ASLANER AK M,Uncu Ulu B,KARAKUS A,Selim Batur D,ALACACIOGLU I,aydın d,Tekinalp A,NAMDAROGLU S,ceran f,Tarkun P,Kiper Unal H,Cetiner M,Yenerel M,Demir A,YILMAZ G,Terzi H,Atilla E,Malkan U,Acar K,Öztürk E,TOMBAK A,Sunu C,salim o,Alayvaz Aslan N,SAYAN S,OZAN O,Ayer M,Gokgoz Z,Andic N,kızılkılıç e,Figen F,Özen M,Pepedil Tanrikulu F,alanoglu g,Ozkan H,aslan v,Çetin G,akyol a,deveci B,Ersoy Dursun F,Dermenci H,Aytan P,Gunduz M,karakuş v,özlü c,Demircioğlu S,akay o,ÖZATLI D,Undar L,Tiftik E,Türköz Sucak G,Haznedaroglu I,Ozcan M,SENCAN M,Tombuloglu M,ozet g,Bilgir O,Turgut B,OZCAN M,Payzın B,Sonmez M,AYYILDIZ M,DAL M,ERTOP S,TURGUT M,Soysal T,Kaya E,ÜNAL A,PEHLİVAN M,ATAGÜNDÜZ I,Fıratlı Tuğlular T,Saydam G,Diz-Kucukkaya R "A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience." Turkish Journal of Hematology, 36, ss.230 - 237, 2019. 10.4274/tjh.galenos.2019.2018.0307
ISNAD	ÇEKDEMIR, DEMET vd. "A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience". Turkish Journal of Hematology 36/4 (2019), 230-237. https://doi.org/10.4274/tjh.galenos.2019.2018.0307