This activity is for healthcare professionals in the USA.

This activity is provided by an independent medical education grant from Sanofi.

The activity is jointly provided by USF Health and touchIME.

Faculty & Disclosures

Listen on the go

    • View and download resources from this activity to support your learning and share with colleagues.

    Download Slides
    Download Practice Aid
    CORRECT!
    Next question
    Faculty & Disclosures
    Prof. Cindy Neunert

    Columbia University Irving Medical Center, New York, NY, USA

    Prof. Cindy Neunert is an associate professor of paediatrics at Columbia University in New York. read more

    She received fellowship training in paediatric haematology–oncology at the University of Texas Southwestern Medical School at Dallas in Texas, where she also obtained her master’s degree in clinical research.

    Her research interests involve assessing patient-related outcomes in disorders of haemostasis and thrombosis. She was chair of the 2019 American Society of Hematology guidelines on the diagnosis and management of immune thrombocytopenia (ITP). She works closely with the Intercontinental Cooperative ITP Study Group and is the former chair of the Pediatric ITP Consortium of North America.

    Prof. Cindy Neunert discloses: Advisory board or panel fees from Janssen; Argenx, Sanofi and Sobi (relationships terminated). Other financial or material support from Genzyme and Sanofi (relationships terminated).
    Prof. David Kuter

    Massachusetts General Hospital, Boston, MA, USA

    Prof. David Kuter is chief of haematology at Massachusetts General Hospital (MGH) and professor of medicine at Harvard Medical School in Boston. read more

    Prof. Kuter divides his time between medical education of fellows and medical students, clinical care of patients with a wide range of haematological disorders, basic science investigation into thrombopoietin and megakaryocyte biology, and clinical research related to thrombopoietic agents and haemolytic anaemia. His basic science group was one of the laboratories that discovered thrombopoietin and his clinical research group carried out various seminal studies using thrombopoietic agents in transfusion medicine, chemotherapy-induced thrombocytopenia and immune thrombocytopenia.

    A member of the American Society of Hematology (ASH), Prof. Kuter is the recipient of a number of awards, including the Irving M. London Teaching Award at Harvard Medical School; the Alfred Kranes Teaching Award at MGH; the 2008 and 2010 Douglas Family Foundation Prize, recognizing excellence in haematology–oncology research at the MGH Cancer Center; the Jane Green Memorial Prize, recognizing excellence in haematology–oncology teaching at the MGH Cancer Center; the 2013 Ernest Beutler Award from ASH; the Thomas R. Spitzer Outstanding Clinician Award at the MGH Cancer Center; and the 2023 MacFarlane Biggs Plenary Lectureship of the British Society for Haematology/British Society for Haemostasis and Thrombosis.

    Prof. Kuter has given over 700 invited lectures in over 50 countries and served as a visiting professor in Beijing, Sydney, Tokyo, London, Durham, Little Rock, Tianjin, Melbourne, and New Haven. Prof. Kuter has authored or co-authored over 350 articles published in international, peer-reviewed journals, including the New England Journal of Medicine, The Lancet and Blood.

    Prof. David Kuter discloses: Consultant for Alexion, Alpine, Amgen, Apellis, Argenx, BioCryst, Bristol Myers Squibb, Caremark, Cellphire, Cellularity, Chugai, Hengrui, Hutchmed, Immunovant, Inmagenebio, Ligand, Merck Sharp Dohme, Novartis, Pfizer, Principia, Regeneron, Rigel, Sanofi, Seismic, Sobi, Takeda, UCB and Verve. Grants/research support from Biocrystal, Hutchmed, Novartis, Principia, Rigel and Sanofi.
    Dr María Eva Mingot Castellano

    Hospital Universitario Virgen del Rocío, Seville, Spain

    Dr María Eva Mingot Castellano is the head of transfusion and tissue establishment area in the Hematology Department, including apheresis and cryopreservation, at the Virgen del Rocío University Hospital, in Seville, Spain. read more

    From 2005 to 2019 she was responsible for haemostasis and thrombosis in adults in the Hematology Department of the Regional University Hospital of Malaga. She has been an associate professor at the University of Seville since 2023 and at the University of Malaga from 2011 to 2019.

    Dr Mingot Castellano is a member of the board of the Spanish Society of Thrombosis and Haemostasis and the Transfusion Accreditation Committee; vice president of the Spanish Apheresis Group; treasurer reference of the Spanish Immune Thrombocytopenia (ITP) Working Group; and coordinator of the Spanish and Portuguese thrombotic thrombocytopenic purpura (TTP) Registry, the Spanish registry of acquired haemophilia, the national ITP and TTP guidelines.

    As of January 2024, Dr Mingot Castellano had 185 documents in Web of Science. Her main areas of interest are immune cytopenias (immune haemolytic anaemia, ITP, TTP, congenital immune cytopenia, acquired haemophilia), critical bleeding, clinical transfusion, haemovigilance and patient blood management.

    Dr María Eva Mingot Castellano discloses: Advisory board or panel fees from Amgen, Grifols, Novartis, Novo Nordisk, Sanofi, Sobi and Takeda. Consultant for Amgen, Grifols, Novartis, Novo Nordisk, Sanofi, Sobi and Takeda. Grants/research support from Amgen, Grifols, Novartis, Novo Nordisk, Sanofi, Sobi and Takeda. Speaker’s bureau fees from Amgen, Grifols, Novartis, Novo Nordisk, Sanofi, Sobi and Takeda.
    Back to Faculty
    touchONCOLOGY touchONCOLOGY
    Start activity

    Poll

    How do you measure patient-reported outcomes in ITP?

    Submit your answer to see the results

    General tools e.g. SF36
       
    ITP-specific tools e.g. ITP Life Quality Index
       
    Your own/institution tools
       
    Other
       
    Do not measure
       

    Poll

    What factors help inform choice of TPO-RA for each patient?

    Submit your answer to see the results

    Cost/insurance considerations
       
    Method of administration
       
    Potential need for dietary restrictions
       
    Other
       

    Poll

    Which of the following do you feel bothers your patients with ITP the most?

    Submit your answer to see the results

    Bleeding events
       
    Fatigue
       
    Anxiety
       
    Cognitive impairment
       
     
    Videos Take CE/CME Test
    Haematology, Rare Diseases CE/CME accredited

    touchSYMPOSIUM
    An enduring activity from a live meeting, experts discuss pertinent data which could improve patient care and outcomes. Close

    Collaboration in chronic ITP: Improving quality of life and patient outcomes

    Faculty Podcast Featured
    Useful tips
    • A practice aid is available for this activity in the Toolkit
    • Downloads including slides are available for this activity in the Toolkit
    Learning Objectives

    After watching this activity, participants should be better able to:

    • Explain the natural history of chronic ITP and its impact on patients
    • Discuss current and future treatment strategies to improve the HRQoL of patients with chronic ITP
    • Practice shared decision-making and collaboration to optimize outcomes for patients with chronic ITP
    Overview

    In this symposium preceding the 66th ASH Annual Meeting and Exposition, hear a patient’s view on the impact of living with immune thrombocytopenia (ITP) and its effect on health-related quality of life. Following this, the expert faculty – Prof. Cindy Neunert (Chair), Prof. David Kuter and Dr María Eva Mingot Castellano – provide practical insights on current and emerging treatments for chronic ITP and how these may be utilized to improve outcomes for patients, including case-based presentations to review management strategies for different patient profiles. Finally, a panel discussion with all three faculty focuses on shared decision-making and collaboration in the clinic, to give patients with chronic ITP the best possible outcomes.

    This activity is jointly provided by USF Health and touchIME. read more

    Target Audience

    This activity has been designed to meet the educational needs of haematologists, including haemato-oncologists, nurses and nurse practitioners involved in the management of ITP.

    Disclosures

    USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

    Faculty

    Prof. Cindy Neunert discloses: Advisory board or panel fees from Janssen; Argenx, Sanofi and Sobi (relationships terminated). Other financial or material support from Genzyme and Sanofi (relationships terminated).

    Prof. David Kuter discloses: Consultant for Alexion, Alpine, Amgen, Apellis, Argenx, BioCryst, Bristol Myers Squibb, Caremark, Cellphire, Cellularity, Chugai, Hengrui, Hutchmed, Immunovant, Inmagenebio, Ligand, Merck Sharp Dohme, Novartis, Pfizer, Principia, Regeneron, Rigel, Sanofi, Seismic, Sobi, Takeda, UCB and Verve. Grants/research support from Biocrystal, Hutchmed, Novartis, Principia, Rigel and Sanofi.

    Dr María Eva Mingot Castellano discloses: Advisory board or panel fees from Amgen, Grifols, Novartis, Novo Nordisk, Sanofi, Sobi and Takeda. Consultant for Amgen, Grifols, Novartis, Novo Nordisk, Sanofi, Sobi and Takeda. Grants/research support from Amgen, Grifols, Novartis, Novo Nordisk, Sanofi, Sobi and Takeda. Speaker’s bureau fees from Amgen, Grifols, Novartis, Novo Nordisk, Sanofi, Sobi and Takeda.

    Content reviewer

    Danielle Walker, DNP, APRN, AGNP-C, has no financial interests/relationships or affiliations in relation to this activity.

    Touch Medical Contributors

    Hannah Fisher and Katrina Lester have no financial interests/relationships or affiliations in relation to this activity.

    USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

    Requirements for Successful Completion

    In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

    If you have questions regarding credit please contact cpdsupport@usf.edu

    Accreditations

    Physicians

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

    USF Health designates this enduring material for a maximum of 1.5 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

    Advanced Practice Providers

    Physician Assistants may claim a maximum of 1.5 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

    The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

    Nurses

    USF Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

    A maximum of 1.5 contact hours may be earned by learners who successfully complete this continuing professional development activity. USF Health, the accredited provider, acknowledges touchIME as the joint provider in the planning and execution of this CNE activity.

    This activity is awarded 1.5 ANCC pharmacotherapeutic contact hour.

    Date of original release: 21 January 2025. Date credits expire: 21 January 2028.

    If you have any questions regarding credit, please contact cpdsupport@usf.edu

    This activity is CE/CME accredited

    To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

    Claim Credit
    Useful tips
    • A practice aid is available for this activity in the Toolkit
    • Downloads including slides are available for this activity in the Toolkit

    You may also be interested in...

    touchIN CONVERSATION

    Optimizing outcomes of JAK inhibition in myelofibrosis: Practical considerations for the clinic

    This activity is CE/CME accredited
    LAUNCH ACTIVITY

    touchIN CONVERSATION

    Selecting the optimal treatment for patients with chronic myeloid leukaemia after two prior lines of therapy

    LAUNCH ACTIVITY

    CONFERENCE HUB

    George Goshua, EHA 2020: Endotheliopathy is Essential in COVID-19 Associated Coagulopathy

    GO TO HUB
    Thumbnails_Karararaj.png

    CONFERENCE HUB

    Austin Kulasekararaj, ASH 2018 – Treatments for Paroxysmal Nocturnal Hemoglobinuria

    GO TO HUB
    webNov5.png

    JOURNALS

    Modulating the Interaction of Stromal-cell-derived Factor-1/CXCL12 and its Receptor, CXCR4, for Enhanced Mobilisation, Homing and Engraftment of Haematopoietic Stem Cells

    GO TO ARTICLE

    JOURNALS

    Assessment of Thrombin Generation

    GO TO ARTICLE

    Topics covered in this activity

    Haematology / Rare Diseases
    REGISTER NOW FOR FREE ACCESS TO
    • 1000+ topical and insightful peer-reviewed journal articles
    • 100+ hours of bite-sized congress highlights
    • 8 major therapy areas packed with the latest scientific advances
    • 150+ specialties offering learn-on-the-go medical education
    • + Concise email updates and newsletters so you never miss out
    Register For Free Now
    This Activity Is Funded By:

    An independent medical education grant from Sanofi.
    This activity is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals in the USA.

    Date of original release: 21 January 2025. Date credits expire: 21 January 2028.

    Claim Credit
    touchSYMPOSIUM
    Collaboration in chronic ITP: Improving quality of life and patient outcomes
    1.5 CE/CME credit
    Question 1/5
    What percentage of adult patients with ITP progress to chronic disease (>12 months)?

    ITP, immune thrombocytopenia.

    Approximately 60% of adults with ITP progress to chronic disease (lasting more than 12 months).

    Abbreviation
    ITP, immune thrombocytopenia.

    Reference
    Moulis G, et al. Rev Med Interne. 2021;42:11–5.

    Question 2/5
    You have a 72-year-old patient with ITP who presented with a platelet count of 22 x 109/L. They have been receiving first-line treatment with 60 mg/d prednisone for 3 weeks; their platelets fluctuate at their weekly blood tests (30–50 x 109/L). What would you do next to manage this patient?

    ITP, immune thrombocytopenia.

    The 2019 ASH guidelines recommend a short course (≤6 weeks) of prednisone for patients with newly diagnosed ITP. The expert panel for the guidelines suggest that there is likely to be limited benefit in continuing corticosteroid therapy beyond 6 weeks; a 6 week trial of corticosteroids should determine if the patient will enter remission or if additional therapy is required (in most patients). The risk of side effects is increased when corticosteroids are used for >6 weeks.

    Abbreviations
    American Society of Hematology; ITP, immune thrombocytopenia.

    Reference
    Neunert C, et al. Blood Adv. 2019:3:3829–66.

    Question 3/5
    After a further 3 weeks of prednisone treatment, you decide to discontinue steroids in this patient as their platelet count remains unstable. You have discussed starting treatment with a TPO-RA. Which of the following factors would you discuss as part of a shared decision-making process to identify the patient’s preferences for their new treatment?

    TPO-RA, thrombopoietin receptor agonist.

    Shared decision-making should empower patients to make decisions about the care that is right for them based on their preferences, beliefs and values.1 TPO-RAs are administered either subcutaneously (romiplostim) or orally (eltrombopag, avatrombopag),2 meaning that patient preference for method of administration should be considered. Romiplostim may be self-administered,3 so all TPO-RAs can be taken at home. Eltrombopag absorption is impacted by the consumption of fat or divalent cations, so dietary restrictions may be required,2,4 which could be off-putting for some patients, whereas avatrombopag can be taken with or without food.2,3

    Abbreviations
    ITP, immune thrombocytopenia; TPO-RA, thrombopoietin receptor agonist.

    References

    1. Maitland H, et al. Hematology. 2024;29:2375177.
    2. FDA PI. Available at: www.accessdata.fda.gov/scripts/cder/daf/index.cfm (accessed 10 December 2024).
    3. Gerard Jansen AJ, et al. Hematology. 2023;28:2267942.
    4. Al-Samkari H, Kuter DJ. Ther Adv Haematol. 2019;10:2040620719841735.
    Question 4/5
    Your patient with ITP has relapsed after treatment with prednisone and a TPO-RA. You are discussing the possibility of entering a rilzabrutinib clinical trial. They ask you what the response rates are for patients with a similar disease history. Based on the pooled analysis from LUNA 2, what would you tell them?

    ITP, immune thrombocytopenia; TPO-RA, thrombopoietin receptor agonist.

    Pooled data from LUNA 2 examined the overall and durable platelet responses by baseline variables in patients with ITP treated with rilzabrutinib (N=71). The analysis found that in all patients, an overall response (defined as ≥50 x 109/L and increased ≥20 x 109/L from baseline) was seen in 41% of patients, whilst a durable response (≥8 of the last 12 platelet counts ≥50 x 109/L) was seen in 28% of patients.

    In patients who received rilzabrutinib in the third line or later (n=62), 37% of patients experienced an overall response and 26% demonstrated a durable response.

    Abbreviation
    ITP, immune thrombocytopenia.

    Reference
    Kuter DJ, et al. Presented at: ISTH 2024, Bangkok, Thailand. 22–26 June 2024. Oral presentation OC 13.3.

    Question 5/5
    How would you describe the impact of sovleplenib on the durable platelet response in patients with ITP in the ESLIM-01 trial? “Compared with placebo, the durable platelet response in patients receiving sovleplenib was…”

    ITP, immune thrombocytopenia.

    Patients with chronic primary ITP receiving sovleplenib (n=126) in the ESLIM-01 trial had a significantly higher durable platelet response (platelet counts of ≥50 x 109/L at 4–6 visits during 14–24 weeks not impacted by rescue treatment) compared with patients who received placebo (48% vs 0%; p<0.0001).

    Abbreviation
    ITP, immune thrombocytopenia.

    Reference
    Hu Y, et al. Lancet Haematol. 2024;11:e567–79.

    Back to Activity

    You may also be interested in...

    touchPANEL DISCUSSION

    Maximizing the possibilities in the evolving treatment paradigm for R/R follicular lymphoma: From optimal sequencing to shared decision-making

    This activity is CE/CME accredited
    LAUNCH ACTIVITY

    touchPANEL DISCUSSION

    Key considerations for treatment selection and sequencing in patients with RRMM: Lessons from real-life clinical practice

    This activity is CE/CME accredited
    LAUNCH ACTIVITY

    CONFERENCE HUB

    The 1st Online Master class in Transplantation and Hematology (MATH) by IACH

    GO TO HUB

    CONFERENCE HUB

    ASH 2019: Day 2 highlights

    GO TO HUB

    JOURNALS

    Iron Deficiency Anemia in Cancer Patients

    GO TO ARTICLE

    JOURNALS

    Identification and Functional Characterisation of von Willebrand Disease

    GO TO ARTICLE
    This Activity Is Funded By:

    An independent medical education grant from Sanofi.
    This activity is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals in the USA.

    Date of original release: 21 January 2025. Date credits expire: 21 January 2028.

    Copied to clipboard!
    accredited arrow-down-editablearrow-downarrow_leftarrow-right-bluearrow-right-dark-bluearrow-right-greenarrow-right-greyarrow-right-orangearrow-right-whitearrow-right-bluearrow-up-orangeavatarcalendarchevron-down consultant-pathologist-nurseconsultant-pathologistcrosscrossdownloademailexclaimationfeedbackfiltergraph-arrowinterviewslinkmdt_iconmenumore_dots nurse-consultantpadlock patient-advocate-pathologistpatient-consultantpatientperson pharmacist-nurseplay_buttonplay-colour-tmcplay-colourAsset 1podcastprinter scenerysearch share single-doctor social_facebooksocial_googleplussocial_instagramsocial_linkedin_altsocial_linkedin_altsocial_pinterestlogo-twitter-glyph-32social_youtubeshape-star (1)tick-bluetick-orangetick-red tick-whiteticktimetranscriptup-arrowwebinar Sponsored Department Location NEW TMM Corporate Services Icons-07NEW TMM Corporate Services Icons-08NEW TMM Corporate Services Icons-09NEW TMM Corporate Services Icons-10NEW TMM Corporate Services Icons-11NEW TMM Corporate Services Icons-12Salary £ TMM-Corp-Site-Icons-01TMM-Corp-Site-Icons-02TMM-Corp-Site-Icons-03TMM-Corp-Site-Icons-04TMM-Corp-Site-Icons-05TMM-Corp-Site-Icons-06TMM-Corp-Site-Icons-07TMM-Corp-Site-Icons-08TMM-Corp-Site-Icons-09TMM-Corp-Site-Icons-10TMM-Corp-Site-Icons-11TMM-Corp-Site-Icons-12TMM-Corp-Site-Icons-13TMM-Corp-Site-Icons-14TMM-Corp-Site-Icons-15TMM-Corp-Site-Icons-16TMM-Corp-Site-Icons-17TMM-Corp-Site-Icons-18TMM-Corp-Site-Icons-19TMM-Corp-Site-Icons-20TMM-Corp-Site-Icons-21TMM-Corp-Site-Icons-22TMM-Corp-Site-Icons-23TMM-Corp-Site-Icons-24TMM-Corp-Site-Icons-25TMM-Corp-Site-Icons-26TMM-Corp-Site-Icons-27TMM-Corp-Site-Icons-28TMM-Corp-Site-Icons-29TMM-Corp-Site-Icons-30TMM-Corp-Site-Icons-31TMM-Corp-Site-Icons-32TMM-Corp-Site-Icons-33TMM-Corp-Site-Icons-34TMM-Corp-Site-Icons-35TMM-Corp-Site-Icons-36TMM-Corp-Site-Icons-37TMM-Corp-Site-Icons-38TMM-Corp-Site-Icons-39TMM-Corp-Site-Icons-40TMM-Corp-Site-Icons-41TMM-Corp-Site-Icons-42TMM-Corp-Site-Icons-43TMM-Corp-Site-Icons-44TMM-Corp-Site-Icons-45TMM-Corp-Site-Icons-46TMM-Corp-Site-Icons-47TMM-Corp-Site-Icons-48TMM-Corp-Site-Icons-49TMM-Corp-Site-Icons-50TMM-Corp-Site-Icons-51TMM-Corp-Site-Icons-52TMM-Corp-Site-Icons-53TMM-Corp-Site-Icons-54TMM-Corp-Site-Icons-55TMM-Corp-Site-Icons-56TMM-Corp-Site-Icons-57TMM-Corp-Site-Icons-58TMM-Corp-Site-Icons-59TMM-Corp-Site-Icons-60TMM-Corp-Site-Icons-61TMM-Corp-Site-Icons-62TMM-Corp-Site-Icons-63TMM-Corp-Site-Icons-64TMM-Corp-Site-Icons-65TMM-Corp-Site-Icons-66TMM-Corp-Site-Icons-67TMM-Corp-Site-Icons-68TMM-Corp-Site-Icons-69TMM-Corp-Site-Icons-70TMM-Corp-Site-Icons-71TMM-Corp-Site-Icons-72
    Close Popup