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Previous Volume 330:1560-1564 June 2, 1994 Number 22 Next

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ABSTRACT

Background Most patients with chronic idiopathic thrombocytopenic purpura have a response to corticosteroids or intravenous immune globulin, but improvement is often transitory. Splenectomy may provide only a short-term benefit. Because pulsed high-dose therapy with potent synthetic corticosteroids is inexpensive, well tolerated, and effective in patients with secretory B-cell neoplasms, a similar regimen was examined for its efficacy in patients with chronic idiopathic thrombocytopenic purpura that was resistant to other treatments.

Methods Ten consecutively referred patients who had persistent symptomatic idiopathic thrombocytopenic purpura after undergoing at least two standard therapies were treated with six cycles of dexamethasone (40 mg per day for 4 sequential days every 28 days).

Results All patients had increased platelet counts (mean [±SD] count before treatment, 12,000 ±8200 per cubic millimeter; after treatment, 248,000 ±130,000 per cubic millimeter). The platelet counts remained above 100,000 per cubic millimeter for at least six months after the last cycle of treatment. There were no serious side effects. Features of hyperadrenocorticism due to prior corticosteroid therapy resolved during treatment. The cost of the drug was approximately $100 per patient.

Conclusions Although the possibility of spontaneous remission and a delayed benefit from prior therapy cannot be excluded in this small group of patients, pulsed high-dose treatment with dexamethasone may provide a low-cost therapeutic option with minimal side effects in patients with refractory idiopathic thrombocytopenic purpura.

Source Information

From the Divison of Hematology and Oncology, Department of Internal Medicine, Wayne State University School of Medicine and Harper Hospital, Detroit.

Address reprint requests to Dr. Andersen at 403 Violet S., Harper Hospital, 3990 John R St., Detroit, MI 48201.

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High-Dose Pulsed Dexamethasone for Immune Thrombocytopenia
Demiroglu H., Dündar S., Andersen J. C.
Extract | Full Text  
N Engl J Med 1997; 337:425-427, Aug 7, 1997. Correspondence

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