Multiagent induction and maintenance therapy for patients with refractory immune thrombocytopenic purpura (ITP)

Donna M. Boruchov, Sri Gururangan, M. Catherine Driscoll, James B. Bussel

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Patients with severe immune thrombocytopenic purpura (ITP) may require an acute increase in the platelet count for surgery or ongoing hemorrhage as well as long-term maintenance treatment. Certain of these patients may be refractory to steroids, intravenous anti-D, intravenous immunoglobulin (IVIG), and splenectomy. Therefore, acute platelet increases were studied in 35 patients completely unresponsive to IVIG or high-dose steroid treatment. Because of their lack of response to either or both single agents, these patients were administered a 3- or 4-drug combination including IVIG 1 g/kg, intravenous methylprednisolone 30 mg/kg, Vinca alkaloids (VCR 0.03 mg/kg), and/or intravenous anti-D (50-75 μg/kg). Subsequent maintenance therapy with the oral combination of danazol (10-15 mg/kg) and azathioprine (2 mg/kg) was given to 18 of the 35 patients. Seventy-one percent of the patients responded to the intravenous combination treatment with acute platelet increases of at least 20×109/L to a level greater than 30×109/L. Two thirds of the patients given maintenance therapy achieved stable platelet counts greater than 50×109/L without other treatments. One patient developed an ileus, but otherwise there was little toxicity of combination treatment. Combination chemotherapy is a useful approach for patients with ITP refractory to conventional treatments both for acute induction and for long-term maintenance therapy.

Original languageEnglish (US)
Pages (from-to)3526-3531
Number of pages6
JournalBlood
Volume110
Issue number10
DOIs
StatePublished - Nov 15 2007
Externally publishedYes

Fingerprint

Idiopathic Thrombocytopenic Purpura
Platelets
Refractory materials
Intravenous Immunoglobulins
Steroids
Vinca Alkaloids
Videocassette recorders
Danazol
Chemotherapy
Methylprednisolone
Azathioprine
Drug Combinations
Therapeutics
Surgery
Platelet Count
Toxicity
Blood Platelets
Rho(D) Immune Globulin
Ileus
Proxy

ASJC Scopus subject areas

  • Hematology

Cite this

Multiagent induction and maintenance therapy for patients with refractory immune thrombocytopenic purpura (ITP). / Boruchov, Donna M.; Gururangan, Sri; Driscoll, M. Catherine; Bussel, James B.

In: Blood, Vol. 110, No. 10, 15.11.2007, p. 3526-3531.

Research output: Contribution to journalArticle

Boruchov, Donna M. ; Gururangan, Sri ; Driscoll, M. Catherine ; Bussel, James B. / Multiagent induction and maintenance therapy for patients with refractory immune thrombocytopenic purpura (ITP). In: Blood. 2007 ; Vol. 110, No. 10. pp. 3526-3531.
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