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KMID : 0366220090440010022
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Korean Journal of Hematology
2009 Volume.44 No. 1 p.22 ~ p.27
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Initial Therapy with High-Dose Dexamethasone for Patients with Idiopathic Thrombocytopenic Purpura
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Yun Jin-A
Kim Chan-Kyu
Kim Kyoung-Ha
Kim Hyun-Jung
Kim Se-Hyung
Park Sung-Kyu
Lee Sang-Cheol
Lee Nam-Su
Bae Sang-Byung
Lee Kyu-Taek
Won Jong-Ho
Park Hee-Sook
Hong Dae-Sik
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Abstract
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Background: Corticosteroids have been widely used for treatingidiopathic thrombocytopenic purpura (ITP) as a first-line treatment. Several different pulsed high-dose dexamethasone therapies for adult ITP have been reported on. We assessed the effectiveness of a single course of high dose dexamethasone as first-line treatment for adult patients with ITP.
Background: The subjects of the study were previously untreated adult patients with newly diagnosed ITP and who had a platelet count of less than 20,000/?L or a platelet count less than 50,000/?L. High-dose dexamethasone at a dose of 40mg/day for four consecutive days was given orally. A response was defined as an increase in the platelet count of at least 30,000/?L and a platelet count of more than 50,000/?L by day 10 after the initial treatment. A sustained response was defined as a platelet count of more than 50,000/?L that was maintained for six months after the initial treatment.
Results: Twenty two patients were eligible. The median platelet count before treatment was 19,000/?L. Seventeen patients (77%) among the 22 patients achieved an initial response by day 10: the mean platelet count 10 days after the initial treatment was 144,000/?L (range: 51,000 to 428,000/?L). Among the patients with a response, 4 (23.5%) had a sustained response, and the other 13 (76.5%) relapsed within six months. All the patients well tolerated the high-dose dexamethasone treatment.
Conclusion: A single course of high-dose dexamethasone is effective as an initial treatment for adults ITP patients, although the response duration is short. To maintain the response, repeated high-dose dexamethasone treatment may be needed or other alternative therapies can be considered.
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KEYWORD
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Idiopathic thrombocytopenic purpura (ITP), Dexamethasone, Treatment
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