AGMR

Primary immune thrombocytopenia (ITP) is entering a new era shaped by precision medicine, digital health, and geroscience, with key implications for patients ≥65 years. In this population, therapy balances efficacy with minimizing systemic toxicity and age-related complications. Corticosteroids are used cautiously due to metabolic, infectious, and neuropsychiatric risks, while thrombopoietin receptor agonists (TPO-RAs) have become preferred for long-term management. Individualized targets (~50–100 ×10⁹/L) aim to ensure hemostasis while limiting thrombotic risk. Advances in immunogenetics, transcriptomics, and pharmacogenomics improve patient stratification and prediction of treatment response and relapse. Artificial intelligence and Big Data applied to integrated clinical and omics datasets support diagnosis, risk modeling, and personalized therapy sequencing. Geriatric-specific assessment—including frailty, fall risk, polypharmacy, cognition, and adherence—combined with digital longitudinal monitoring, enhances preventive care. These innovations underpin the concept of geriatric–immune systemic ITP (G-ITP), framing ITP in older adults as a systemic disorder influenced by immunosenescence, clonal hematopoiesis, endothelial dysfunction, and frailty rather than isolated autoimmunity. Integrating comprehensive geriatric assessment with personalized TPO-RA therapy may improve outcomes and reduce morbidity, establishing ITP as a model for geroscience-informed, patient-centered immune care.

immune thrombocytopenia; elderly patients; geriatric assessment; artificial intelligence (ai); predictive medicine; molecular biology; polypharmacy; thrombotic risk; personalized medicine