Assessment of the immunomodulatory cytokines interleukin-35, interleukin-10, and transforming growth factor-β in patients with idiopathic immune thrombocytopenia purpura on treatment with romiplostim: A cross-sectional analysis

Abstract: BACKGROUND: Idiopathic immune thrombocytopenia purpura is an autoimmune bleeding disorder that accounts for approximately one-third of clinical hemorrhagic diseases. Pathophysiologically, it involves a complicated imbalance in the immune system. OBJECTIVES: This study focuses on evaluating the levels of the immunomodulatory cytokines interleukin (IL)-35, interleukin-10, and transforming growth factor-β (TGF)-β in patients with refractory idiopathic immune thrombocytopenia undergoing treatment with romiplostim. MATERIALS AND METHODS: A cross-sectional study encompassed 78 individuals with idiopathic immune thrombocytopenia and conducted measurements of different immunomodulatory cytokines in response to different responses of idiopathic immune thrombocytopenia patients on romiplostim therapy. The research was carried out from May 1, 2025, to September 1, 2025, and it was conducted at the Haematology and Bone Marrow Transplant Centre, Medical City, Baghdad, Iraq. RESULTS: More than half of them have responded to romiplostim 52 (66.7%) with a mean dose of 103.8 mcg. The study demonstrated a notable link between immunomodulatory cytokines (IL-10, IL-35, and TGF-β) and platelet count; however, no significant difference was found between responders and nonresponders regarding these cytokines. CONCLUSIONS: Romiplostim demonstrated effective management in Iraqi patients, and the Treg cells and their associated cytokines (IL-35, IL-10, and TGF-β) may contribute to immune system dysregulation in adult patients with chronic idiopathic immune thrombocytopenia.