Therapeutic Response of Different Treatment Modalities in the Adult Idiopathic Thrombocytopenic Purpura / 대한혈액학회지

ABSTRACT

BACKGROUND: Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a severe reduction in the number of circulating platelets. Corticosteroid therapy, which has been used in ITP for many years, has produced a complete or partial response rate of 65% to 75%, although sustained remissions have been reported in only 18% to 32% of the patients. The purpose of the present study is to define response to each treatment and ultimate outcome of adults with ITP. METHOD: A clinical study was done on 35 cases of ITP who had admitted to the department of Internal Medicine, Yeungnam University Hospital from June 1983 to July 1996. The response of each treatment modalities was based on criteria of Defino and Cooperative Latin American Group on Hemostasis and Thrombosis. RESULTS: The mean age of patients was 41.9 years old and female to male ratio was 10.6 (female22 cases, male13 cases). The complete response rate to intravenous gamma-globulin as early therapy was obtained in 72% of the patients and the duration to platelet count above 50,000/ microliter was 3 days after intravenous gamma-globulin therapy. Duration of response was 15 days. The CCR (continuing complete response) to corticosteroid was obtained in 16% of the patients, and no CCR to reinduction with corticosteroid was observed. The CR to splenectomy was obtained in 85% of the patients. The overall results of all therapeutic modalities were CCR 43%, TCR (temporary complete response) 20%, PR (partial response) 31%, and NR (no response) 6%. CONCLUSION: This analysis of ITP in adults suggests that splenectomy remains as the most effective treatment and intravenous gamma-globulin is effective for rapid elevation of platelet count.