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KMID : 0387820060130020143
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Clinical Pediatric Hematology-Oncology
2006 Volume.13 No. 2 p.143 ~ p.149
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Efficacy of Very Low-dose (200 mg/kg/d) with Short-term Intravenous Immunoglobulin G Therapy according to Individual Response of Acute Immune Thrombocytopenic Purpura in Childhood
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Lee Ji-Hye
Lee Kun-Soo
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Abstract
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Purpose: Immune thrombocytopenic purpura (ITP) is a common bleeding disorder in children and rarely complicated by severe hemorrhage. To reduce life-threatening complication, intravenous immunoglobulin G (IVIG) therapy has been used. We tried touse IVIG according to the patient’s response for reducing the dose. This study designed to evaluate the efficacy of very low-dose with short-term IVIG therapy for childhood acute ITP according to individual clinical response.
Methods: We attempted 200 mg/kg/day IVIG therapy to raise the platelet counts over 50,000/mm3 in 26 childhood acute ITP who were newly diagnosed at the Department of Pediatrics, Kyungpook National University Hospital from January, 2005 to August, 2006. We evaluated the time to reach targeted platelet count and the rate of re-treatment within 1 month, relapse and diagnosis to chronic ITP.
Results: The median age was 4.6 years (2 months～14.5 years) and male to female ratio was same and the median follow up duration was 7 months (1 month～17 months). The median platelet count was 8,000/mm3 (2,000~30,000/mm3) at diagnosis and increased to 32,500/mm3 (1,000～86,000/mm3) after 1 day, 45,000/mm3 (1,000～158,000/mm3) after 2 days, 65,000/mm3 (3,000～242,000/mm3) after 3 days of IVIG therapy. The median duration of IVIG therapy was 3 days (1～7 days) and all patients reached platelet count over 50,000/mm3. Eight patients (30.8%) were re-treated and the median interval to re-treatment was 14 days (9～23 days). Four patients (15.4%) were relapsed and the median interval to relapse was 2.8 months. Among 13 patients who were followed up over 6 months, 3 patients (23.1%) were diagnosed to chronic ITP and the chronic ITP was more frequent in re-treated group (P=0.003). There were no complication and side effect of treatment during study period.
Conclusion: Treatment with very low-dose and short-term IVIG according to individual clinical response is effective and safe in childhood acute ITP.
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KEYWORD
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Immune thrombocytopenic purpura, Childhood, Intravenous immunoglobulin, Very low-dose, Short-term
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