title: Combination immunosuppressant therapy for patients with chronic refractory immune thrombocytopenic purpura.
abstract: Treatment options for patients with chronic refractory immune thrombocytopenic purpura (ITP) are limited. Because combination immunosuppressant therapy appeared to be effective in ITP and other disorders, we used this approach in patients with particularly severe and refractory ITP. In this retrospective, observational study, we determined the response (platelet count above 30 x 10(9)/L and doubling of baseline) among 19 refractory ITP patients. Treatment consisted of azathioprine, mycophenolate mofetil, and cyclosporine. The patients had failed a median of 6 prior treatments, including splenectomy (in all except 1). Of 19 patients, 14 (73.7%) achieved a response lasting a median of 24 months, after which time 8 (57.1%) relapsed. Of the 8 relapsing patients, 6 responded to additional treatments. Of the 14 patients who achieved an initial response, 2 (14.3%) remained in remission after eventually stopping all medications. Severe adverse events did not occur. Combination immunosuppressant therapy can produce a rise in the platelet count that is sometimes sustained in refractory ITP patients.
authors.affiliation: Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada. arnold@mcmaster.ca
authors.forename: Donald M
authors.initials: DM
authors.lastname: Arnold
authors.forename: Ishac
authors.initials: I
authors.lastname: Nazi
authors.forename: Aurelio
authors.initials: A
authors.lastname: Santos
authors.forename: Howard
authors.initials: H
authors.lastname: Chan
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Heddle
authors.forename: Theodore E
authors.initials: TE
authors.lastname: Warkentin
authors.forename: John G
authors.initials: JG
authors.lastname: Kelton
mesh_terms: D001379:Azathioprine / Q000627:therapeutic use; D002908:Chronic Disease; D016572:Cyclosporine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy* / Q000517:prevention & control*; D012008:Recurrence
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D001379:Azathioprine