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 journalArticlepeer-review

79 Scopus citations

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

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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