In 2022, Allison Imahiyerobo, an Advanced Practice Nurse at the Englewood Health Physician Network in New Jersey, led a continuing medical education (CME)/nursing continuing professional development (NCPD)–approved activity with i3 Health, New Insights and Avenues for Improved Patient Outcomes in Immune Thrombocytopenia. A year later, Ms. Imahiyerobo sat down with Oncology Data Advisor to discuss additional advancements and updates in ITP management and patient care since recording.

Oncology Data Advisor: Welcome to Oncology Data Advisor, a digital resource for the multidisciplinary cancer team. Today I'm joined by Ms. Alli Imahiyerobo, who is an Advanced Practice Nurse at the Englewood Health Physician Network. Recently, she led an activity regarding health care strategies for immune thrombocytopenia. Today, she's updating us on advancement since recording and why it is important to partake in this educational activity.

Thank you so much for joining us today. Would you like to introduce yourself and tell us a bit about your research and what you do?

Allison Imahiyerobo, APN: Sure. My name is Alli Imahiyerobo and I'm a Clinical Nurse Practitioner. I focus on hematology and oncology, and I work in a private practice in Englewood, New Jersey based at Englewood Hospital. In my clinical practice, I see a wide variety of diagnoses, but I do prefer to focus on platelet disorders and have filled up quite a population—a big patient population—of platelet disorder patients.

Oncology Data Advisor: Thank you again for joining us today. First question I have for you, since recording the activity, have there been any updates on quality-of-life strategies when treating immune thrombocytopenia (ITP)?

Ms. Imahiyerobo: I think a little bit is, when the American Society of Hematology (ASH) guidelines changed in 2019, there was a lot of emphasis put on shared decision making with patients. And so, that's been a big focus of my practice this year as not a "one size fits all." When we get to the second-line treatment choices for our patients, really trying to talk to them about their preferences, pros and cons of each treatment, and how it fits in with their life, I think is one of our most important jobs in treating ITP patients. So, that's been a big focus of my practice this year. And then I think another update is that there have been some updates, and mostly these have been ASH abstracts, but there have been some links to lower platelet counts and obesity, which I think is really interesting because previously I felt that the research didn't really show that lifestyle played a big role in ITP.

This is the first link that helps me tell my patients, "Okay, you need to have a healthy lifestyle. You need to exercise; you need to try to maintain a healthy weight." I think that's really exciting because I can finally say there's some proof that being thin is going to actually be good for your platelet counts—or may be good for your platelet counts. And then there were two other really exciting abstracts that came out that linked patients with ITP and showed some cognitive impairment. We already know that fatigue plays a big role in our patients' lives, but now we should start to think about assessing our patients for cognitive impairment.

Oncology Data Advisor: So why is it particularly important to stay updated on treatment options and supportive care strategies for immune thrombocytopenia?

Ms. Imahiyerobo: Well, I think a couple reasons. One is that not one treatment fits all patients. So, it can't be a linear algorithm for treatment. We need to know about what else is out there. We're lucky now that we have a lot of experience with thrombopoietin (TPO) drugs, and that's a mainstay in ITP practice now. So, most clinicians are pretty well versed in that, but then we are all going to have a patient or two a year that is so difficult to treat and really needs something else out there. If we don't know what else is out there or where to look, then we're not helping those patients and we may just be giving them too many steroids or unnecessarily hospitalizing them. What they really need is a clinical trial, and we have to know where to look for that.

Oncology Data Advisor: Considering where to look in staying up to date on that topic, are there any current clinical trials or studies that you're keeping an eye on or participating in that you would like to mention?

Ms. Imahiyerobo: So, I think there are a few that are really exciting. We had the TPO that's been now approved for a while, and then we, more recently, had spleen tyrosine kinase (SYK) inhibitors approved. But there's really exciting research in the plasma cell area with drugs like daratumumab. There's also research that's undergoing with neonatal FcRn blockade, which is really promising. There was an abstract that showed that COVID vaccinations are safe in patients with ITP and that a really small percent of the patients had a relapse in their disease. So, I think that's really helpful for clinicians to know that we can advocate for COVID vaccination as we get further out from COVID.

And then the final thing I'm seeing research in is in complement with inhibition, because we know that ITP is a heterogeneous disease. And so, these new forms of research show that we could target different pathways. This may be helpful for difficult-to-treat patients, but all of these are in phase 2, phase 3. So, for our patients to receive these medicines right now, they would have to go on a clinical trial. The best way to do that is to just go on clinicaltrials.gov or contact one of the ITP thought leaders and see what they think. That's what I do for my difficult patients.

Oncology Data Advisor: Is there anything you would like to add on, any particular patient-care techniques, or just techniques in general, that could improve practice, or what you think other clinicians could benefit from?

Ms. Imahiyerobo: Well, I really try not to scare my patients when their platelet counts are low. I try to stay cool, calm, and collected because I think the second that they see us worried about their platelets, they're more worried about their platelets, and that may lead to lack of trust with their health care provider. I think that building trust with your patients is one of the most important things we can do, especially with this disease. So that works well for me.

I think the other thing my patients like a lot is, I always give them a prescription to keep in their wallet so that way they can feel like they can live their life. If, hey, they happen to be on a trip or develop bleeding symptoms and they can't get into the office right away, they know that they can go to a lab. And then the results are available later that day or the next day. So, that works well for my patients, and I encourage them to trust their symptoms. So, not to feel like they have to know the number, but instead to say, "Okay, well I don't have bruises, I don't have petechiae, I don't have blisters in my mouth. That means I'm probably fine." And that works really well too.

And so, upfront when I'm meeting my patients, I spend a lot of time educating them about the symptoms and about what their symptoms are, because different patients have different symptoms and I think that helps them a lot, knowing that they're okay.

Oncology Data Advisor: Do you have any resources specifically for the health care team or other clinicians, that you think would be helpful in staying up-to-date and making sure that we're doing our best to take care of our patients?

Ms. Imahiyerobo: Well, I think if you're not sure if you know what to do for your patient or how to treat them next, I would look at ASH, the recent ASH guidelines, and ASH abstracts, to see what's new. I think that some of the thought leaders in ITP are really great about fielding emails with, "Hey, this is what's going on with my patient. What do you think I should do next?" Especially in the era of virtual medicine, having your difficult-to-treat patients see somebody that's in a different state can be helpful resource.

The other thing that I think is really helpful for patients is to refer them to the PDSA, which is the Platelet Disorders Patient Advocacy Group, because they have a lot of really great patient-friendly resources with different treatment options and side effects of treatments. Sometimes when we're talking to our patients about these treatments and the side effects, maybe we talk in a medical lingo that's over their heads. So, sometimes I think it's helpful to be able to turn them back around and say, "Okay, well here's a resource that is actually written for you, go read it and then we'll talk about it next week or at our next visit." That's my go-to approach. And then, I think I mentioned this the last time we spoke, but there's an app for patients to track their symptoms, which I think patients like a lot. So, those are my main things that I'm doing right now.

Oncology Data Advisor: Thank you so much. That's all the questions I had for you today. So, thank you for your research and for your time.

Ms. Imahiyerobo: My pleasure.

About Ms. Imahiyerobo

Allison Imahiyerobo is an Advanced Practice Nurse at the Englewood Health Physician Network in New Jersey. Ms. Imahiyerobo's research and clinical interests lie in oncology and hematology, with a focus on platelet disorders. She is a member of the American Academy of Nurse Practitioners and the Oncology Nursing Society, and she was the recipient of the 2018 Columbia University Irving Medical Center Liquid Nurse Practitioner of the Year Award. She has authored and coauthored several publications focusing on improving outcomes in patients with hematologic malignancies.

For More Information

Stefani S, Saputil RC, Tan MMH, et al (2022). Safety and efficacy of SARS-CoV-2 vaccination in patients with immune thrombocytopaenia: a multi-centre review. Blood, 15;140:5546–8. DOI:10.1182/blood-2022-167614

Platelet Disorder Support Association (2023). Available at: https://www.pdsa.org/

This transcript has been edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of i3 Health.