title: Efficacy of amifostine in treating patients with idiopathic thrombocytopenia purpura.
abstract: Idiopathic Thrombocytopenic Purpura (ITP) is an autoimmune disease characterized by the production of antibodies against platelet surface antigens, resulting in platelet destruction. ITP is generally treated using glucocorticoids, splenectomy, immunosuppressants, platelet transfusions, and also rituxan and rituximab. However, as these treatments are not effective in some refractory ITP patients, especially the elderly, who are also at greater risk of cerebral hemorrhage, we have undertaken this study to find a safe and effective way of treating these patients. In a clinical protocol, we have examined the efficacy of the cytoprotective adjuvant, amifostine, on 24 ITP patients, consisting of 21 Chinese (age: 13-92 years), and 3 Caucasians (age: 46-73 years). In order to prevent the side effects associated with amifostine treatment, an alternative dosing and anti-emetic regimen was developed as part of this protocol, which significantly improved patient acceptance. The protocol consisted of daily intravenous infusions of amifostine 5 × 400 mg per week, for a total of 4-5 weeks. All the patients experienced a long-lasting and continuing remission, defined as platelet counts greater than 100,000. Two patients relapsed: one after an upper respiratory tract infection, and another due to Helicobacter pylori. However, both these patients had complete remission, after they were treated again with amifostine. In this clinical study, we report for the first time, the successful use of amifostine for ITP treatment in refractory patients. In conclusion, amifostine may have good therapeutic effect on ITP patients, especially in refractory and/or elderly. The long-term clinical outcome and the mechanism of action of this drug still need further investigation.
authors.affiliation: Department of Geriatric Haematology, General Hospital of PLA, 28 Fuxing Street, Beijing 100853, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Fan
authors.forename: Hong-Li
authors.initials: HL
authors.lastname: Zhu
authors.forename: Su-Xia
authors.initials: SX
authors.lastname: Li
authors.forename: Xue-Chun
authors.initials: XC
authors.lastname: Lu
authors.forename: Bing
authors.initials: B
authors.lastname: Zhai
authors.forename: Bo
authors.initials: B
authors.lastname: Guo
authors.forename: Shan-Qian
authors.initials: SQ
authors.lastname: Yao
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004999:Amifostine / Q000009:adverse effects / Q000627:therapeutic use*; D000932:Antiemetics / Q000627:therapeutic use; D001792:Blood Platelets / Q000187:drug effects / Q000473:pathology; D019610:Cytoprotection; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000188:drug therapy*
chemical_list: D000932:Antiemetics; D004999:Amifostine