Splenectomy-sparing, long-term maintenance with anti-D for chronic immune (idiopathic) thrombocytopenic purpura: the New York Hospital experience.
For nonsplenectomized children and adults with chronic or acute immune (idiopathic) thrombocytopenic purpura (ITP), anti-D has been shown to be a safe and effective treatment, providing hemostatic platelet increases in more than 70% of patients. Children had the best results, but all patient groups responded. In our recently published series, the effect of anti-D therapy lasted for more than 21 days in 50% of the responders and for more than 1 month in 37%. The use of anti-D as maintenance therapy was evaluated in a subset of patients. Of those who responded to the initial anti-D infusion, 79 patients (44 children, 35 adults) received 3 consecutive treatments. There were no significant differences in the responses after each infusion. Fifty-eight patients responded to all 3 treatments; of those, 20 (9 children, 11 adults) continued anti-D therapy, receiving an average of 18 infusions each (range, 10 to 36). The overall response rate was 86%. The ease of administration, duration of effect, and infrequent development of tachyphylaxis make anti-D an attractive alternative for maintenance therapy, particularly for children with ITP who have a high rate of spontaneous remissions. Use of anti-D as a means of spearing the spleen or, at least, postponing splenectomy should now be considered as a clinical option in the management of adult patients with chronic ITP.
Scaradavou
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Department of Pediatrics, Hematology and Oncology, New York Hospital-Cornell Medical Center, New York 10021, USA.
D000328:Adult; D002648:Child; D002675:Child, Preschool; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D007518:Isoantibodies / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009518:New York; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy* / Q000601:surgery*; D018029:Rho(D) Immune Globulin; D013156:Splenectomy; D013997:Time Factors; D016896:Treatment Outcome
D007518:Isoantibodies; C061961:RHO(D) antibody; D018029:Rho(D) Immune Globulin