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Platelet and immune responses to oral cyclic dexamethasone therapy in childhood chronic immune thrombocytopenic purpura

Kuhne, T. ; Freedman, J. ; Semple, J. W. LU ; Doyle, J. ; Butchart, S. and Blanchette, V. S. (1997) In Journal of Pediatrics 130(1). p.17-24
Abstract

Objective: To examine the effectiveness of cyclic oral high-dose (HD) dexamethasone therapy in pediatric patients with chronic immune thrombocytopenic purpura (ITP), which has been reported to cause complete remission in adults with chronic ITP. Study design: Eleven children with primary chronic ITP, with a median disease duration of 28 months (range, 6 to 120 months), were treated with cycles of HD dexamethasone therapy. Results: Excellent short-term responses (initial platelet counts ≤50 x 109/L, increasing to > 100 x 109/L within 72 hours of completion of an HD dexamethasone cycle) were observed in 78% of 41 cycles. Long-term effects include one complete response (platelet count ≤150 x 109/L) and... (More)

Objective: To examine the effectiveness of cyclic oral high-dose (HD) dexamethasone therapy in pediatric patients with chronic immune thrombocytopenic purpura (ITP), which has been reported to cause complete remission in adults with chronic ITP. Study design: Eleven children with primary chronic ITP, with a median disease duration of 28 months (range, 6 to 120 months), were treated with cycles of HD dexamethasone therapy. Results: Excellent short-term responses (initial platelet counts ≤50 x 109/L, increasing to > 100 x 109/L within 72 hours of completion of an HD dexamethasone cycle) were observed in 78% of 41 cycles. Long-term effects include one complete response (platelet count ≤150 x 109/L) and three partial responses (platelet count ≤50 and < 150 x 109/L) in 11 children followed for 6 or more months after completing cyclic HD dexamethasone therapy. Because side effects were substantial, three children did not complete their sixth treatment cycle. At day 6 of treatment, B lymphocytes were significantly increased (p = 0.005). Conclusions: Dexamethasone, given orally in high doses, is an effective drug in achieving short-term platelet responses, but it induced long-term remissions in fewer than half of the children with well-established chronic ITP. Its effect on B lymphocytes requires further elucidation. A prospective, controlled study will be needed to establish whether cyclic HD dexamethasone therapy can alter the natural history of children with early chronic ITP and thus avoid splenectomy.

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author
; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
in
Journal of Pediatrics
volume
130
issue
1
pages
8 pages
publisher
Academic Press
external identifiers
  • scopus:0030785539
  • pmid:9003846
ISSN
0022-3476
DOI
10.1016/S0022-3476(97)70305-6
language
English
LU publication?
no
id
a0e55fb9-17a6-4779-aadc-3b0b6ac5ddd6
date added to LUP
2019-12-03 10:30:36
date last changed
2020-09-23 08:00:43
@article{a0e55fb9-17a6-4779-aadc-3b0b6ac5ddd6,
  abstract     = {<p>Objective: To examine the effectiveness of cyclic oral high-dose (HD) dexamethasone therapy in pediatric patients with chronic immune thrombocytopenic purpura (ITP), which has been reported to cause complete remission in adults with chronic ITP. Study design: Eleven children with primary chronic ITP, with a median disease duration of 28 months (range, 6 to 120 months), were treated with cycles of HD dexamethasone therapy. Results: Excellent short-term responses (initial platelet counts ≤50 x 10<sup>9</sup>/L, increasing to &gt; 100 x 10<sup>9</sup>/L within 72 hours of completion of an HD dexamethasone cycle) were observed in 78% of 41 cycles. Long-term effects include one complete response (platelet count ≤150 x 10<sup>9</sup>/L) and three partial responses (platelet count ≤50 and &lt; 150 x 10<sup>9</sup>/L) in 11 children followed for 6 or more months after completing cyclic HD dexamethasone therapy. Because side effects were substantial, three children did not complete their sixth treatment cycle. At day 6 of treatment, B lymphocytes were significantly increased (p = 0.005). Conclusions: Dexamethasone, given orally in high doses, is an effective drug in achieving short-term platelet responses, but it induced long-term remissions in fewer than half of the children with well-established chronic ITP. Its effect on B lymphocytes requires further elucidation. A prospective, controlled study will be needed to establish whether cyclic HD dexamethasone therapy can alter the natural history of children with early chronic ITP and thus avoid splenectomy.</p>},
  author       = {Kuhne, T. and Freedman, J. and Semple, J. W. and Doyle, J. and Butchart, S. and Blanchette, V. S.},
  issn         = {0022-3476},
  language     = {eng},
  month        = {01},
  number       = {1},
  pages        = {17--24},
  publisher    = {Academic Press},
  series       = {Journal of Pediatrics},
  title        = {Platelet and immune responses to oral cyclic dexamethasone therapy in childhood chronic immune thrombocytopenic purpura},
  url          = {http://dx.doi.org/10.1016/S0022-3476(97)70305-6},
  doi          = {10.1016/S0022-3476(97)70305-6},
  volume       = {130},
  year         = {1997},
}