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J Pediatr. 1997 Jan;130(1):17-24.

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

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  • 1Division of Hematology/Oncology, Hospital for Sick Children and St. Michael's Hospital, University of Toronto, Ontario, Canada.

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 < or = 50 x 10(9)/L, increasing to > 100 x 10(9)/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 > or = 150 x 10(9)/L) and three partial responses (platelet count > or = 50 and < 150 x 10(9)/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.

PMID:
9003846
[PubMed - indexed for MEDLINE]
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