[Efficacy of various treatments in the management of idiopathic thrombocytopenic purpura in the adult].
OBJECTIVE
To evaluate the ITP treatment modalities and their results in a series of 30 adult patients.


METHODS
30 patients, age 15-74, were diagnosed of ITP in our institution between 1988 and December 1991. We defined the ITP as: mild (platelets > or = 50 x 10(9)/L and < or = 120 x 10(9)/L), moderate (platelets 25-50 x 10(9)/L) and severe (platelets < or = 25 x 10(9)/L). Treatment was initiated when the platelet count reached a level < 50 x 10(9)/L. Initial therapy was oral prednisone or methyl-prednisolone in all patients. In 12 unresponsive patients the treatment included splenectomy. Patients who fail steroid therapy and splenectomy received additional lines of therapy, that included: vincristine (n = 2), vinblastine (n = 1), danazol (n = 5), anti D immunoglobulin (n = 6), methotrexate (n = 2), intravenous immunoglobulin (n = 3).


RESULTS
Complete remission was obtained in 19 patients with a follow-up of 3 to 55 months (median, 30 months). Partial remission was achieved in 4 patients, that was sustained for 9 to 39 months (median, 22.5 months) after initial therapy. One unresponsive patient died of infection. Six mild ITP patients did not require therapy with a follow-up of 14 to 56 months (median, 33.1 months).


CONCLUSIONS
In adult patients with mild ITP, therapy is not required. Steroid therapy remains the initial therapeutic choice for moderate and severe ITP. In unresponsive patients useful alternative choices are splenectomy, danazol, anti D immunoglobulin and methotrexate.
Llamas
P
P
Servicio de Hematología y Hemoterapia, Clínica Puerta de Hierro, Universidad Autónoma de Madrid.
Busto
M J
MJ
Díez
J L
JL
Cabrera
R
R
Regidor
C
C
Forés
R
R
Sanjuán
I
I
Briz
M
M
Fernández
M N
MN
D000293:Adolescent; D000328:Adult; D001327:Autoimmune Diseases / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012074:Remission Induction; D013156:Splenectomy; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D011241:Prednisone; D008775:Methylprednisolone
Eficacia de distintos tratamientos en el manejo de la púrpura trombocitopénica idiopática (PTI) del adulto.