title: Platelet production rate predicts the response to prednisone therapy in patients with idiopathic thrombocytopenic purpura.
abstract: The predictive value of clinical and platelet kinetic parameters for treatment outcome in idiopathic thrombocytopenic purpura (ITP) was investigated in 75 patients with platelets<or=20x10(9)/L. The platelet kinetic studies showed that the platelet production rate (PPR) was decreased (<100x10(9)/day), normal, or increased (>355x10(9)/day) in 33%, 48%, and 19% of patients, respectively. All patients started with prednisone at diagnosis (1 mg/kg/day). Initial complete and partial response (CR/PR) rate was 84% and a durable CR/PR (>or=6 months without treatment) was attained in 44% of the patients. Durable CR/PR was noticed in 64% of the patients with decreased PPR during a median follow-up time without treatment of 81 (range 18-92) months, compared to 34% of the patients with normal or increased PPR during a median follow-up time without treatment of 141 (range 10-284) months (p=0.03). Splenectomy was performed in 32% of patients with decreased PPR and in 62% of patients with normal or increased PPR (p=0.03). In conclusion, ITP patients with suppressed PPR have a significant higher durable CR/PR rate to prednisone therapy and are less frequently exposed to splenectomy than those with a normal or increased PPR.
authors.affiliation: Department of Hematology, University Medical Center Groningen, PO Box 30001, 9700 RB, and Department of Nuclear Medicine, Martin Hospital Groningen, Groningen, The Netherlands. e.j.houwerzijl@int.umcg.nl
authors.forename: Ewout J
authors.initials: EJ
authors.lastname: Houwerzijl
authors.forename: Henk
authors.initials: H
authors.lastname: Louwes
authors.forename: Wim J
authors.initials: WJ
authors.lastname: Sluiter
authors.forename: Jan W
authors.initials: JW
authors.lastname: Smit
authors.forename: Edo
authors.initials: E
authors.lastname: Vellenga
authors.forename: Joost Th M
authors.initials: JT
authors.lastname: de Wolf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001792:Blood Platelets / Q000187:drug effects* / Q000502:physiology; D016022:Case-Control Studies; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D012074:Remission Induction; D013156:Splenectomy; D034061:Thrombopoiesis / Q000187:drug effects* / Q000502:physiology
chemical_list: D005938:Glucocorticoids; D011241:Prednisone