Beyond platelet response: toward an immune remission framework in immune thrombocytopenia
- 1Department of Rheumatology and Immunology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University
Abstract
Platelet response and clinical remission remain central measures of clinical control in immune thrombocytopenia (ITP), but they do not establish whether disease-relevant immune activity has durably receded. We propose immune remission as a provisional, multidimensional research construct: a sustained reduction in disease-relevant immune activity across more than one mechanistic domain, demonstrated longitudinally beyond platelet recovery and treatment-related effects, and evaluated against durable clinical control or relapse. The framework comprises six interconnected analytical domains: B-cell regulation, T-cell regulation, the Fc/antibody interface, the bone marrow immune niche, complement regulation, and innate immune activation. These domains are pragmatic modules rather than independent pathways, and they differ in causal position, measurability, and evidence maturity. The framework does not require normalization of every immune measure to a healthy-control range or elimination of all autoreactive lymphocytes. It preserves platelet response, bleeding risk, and treatment burden as clinical anchors and does not currently support routine immune testing, prediction, treatment extension, or withdrawal decisions. Operationalization requires prespecified assays and time points, longitudinal within-patient analysis, separation of disease change from treatment effects, external validation, and demonstration of added clinical value. Immune remission is therefore presented as a testable research framework, not a validated clinical endpoint.
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BibTeX
@article{pan2026beyond,
title = {{Beyond platelet response: toward an immune remission framework in immune thrombocytopenia}},
author = {Zhenglun Pan},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1974216},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1974216/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Beyond platelet response: toward an immune remission framework in immune thrombocytopenia
AU - Zhenglun Pan
PY - 2026
DA - 2026/10/20
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1974216
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1974216/full
AB - Platelet response and clinical remission remain central measures of clinical control in immune thrombocytopenia (ITP), but they do not establish whether disease-relevant immune activity has durably receded. We propose immune remission as a provisional, multidimensional research construct: a sustained reduction in disease-relevant immune activity across more than one mechanistic domain, demonstrated longitudinally beyond platelet recovery and treatment-related effects, and evaluated against durable clinical control or relapse. The framework comprises six interconnected analytical domains: B-cell regulation, T-cell regulation, the Fc/antibody interface, the bone marrow immune niche, complement regulation, and innate immune activation. These domains are pragmatic modules rather than independent pathways, and they differ in causal position, measurability, and evidence maturity. The framework does not require normalization of every immune measure to a healthy-control range or elimination of all autoreactive lymphocytes. It preserves platelet response, bleeding risk, and treatment burden as clinical anchors and does not currently support routine immune testing, prediction, treatment extension, or withdrawal decisions. Operationalization requires prespecified assays and time points, longitudinal within-patient analysis, separation of disease change from treatment effects, external validation, and demonstration of added clinical value. Immune remission is therefore presented as a testable research framework, not a validated clinical endpoint.
SN - 1664-3224
ER -