Пульс-терапия идиопатической тромбоцитопенической пурпуры дексаметазоном

[Dr.Vad]

Blood. 2006 Oct 31;

Therapy with high-dose dexamethasone (HD-DXM) in previously untreated patients affected by idiopathic thrombocytopenic purpura. A GIMEMA experience.

Mazzucconi MG, Fazi P, Bernasconi S, De Rossi G, Leone G, Gugliotta L, Vianelli N, Avvisati G, Rodeghiero F, Amendola A, Baronci C, Carbone C, Quattrin S, Fioritoni G, D'Alfonso G, Mandelli F.

Universita degli Studi di Roma "La Sapienza", Italy.

In Idiopathic Thrombocytopenic Purpura (ITP) corticosteroids have been widely recognized as the most appropriate first-line treatment, even if the best therapeutic approach is still a matter of debate. Recently, a single HD-DXM course was administered as first-line therapy in adult ITP patients. In this paper we show the results of two prospective pilot studies (monocentric and a multicentric, respectively) concerning the use of repeated pulses of HD-DXM in untreated ITP patients. Monocentre study: 37 severe ITP patients, age >/= 20 and </= 65, were enrolled. HD-DXM, in 4 day pulses, every 28 days, for 6 cycles was given. Response rate was 89.2%; relapse free survival (RFS) 90% at 15 months; long-term responses, lasting for a median time of 26 months (6-77), were 25/37 (67.6%). Multicentre study: 95 severe ITP patients, age >/= 2 and </= 70, were enrolled HD-DXM in 4 days pulses, every 14 days, for 4 cycles was given, 90 completed 4 cycles. Response rate (85.6%) was similar in patients classified by age (<18 years, 36/42= 85.7%; >/= 18 years, 41/48= 85.4%, p=n.s.), with a statistically significant difference between the second and third cycle (75.8% vs 89%, p=0.018). RFS at 15 months 81%; long-term responses, lasting for a median time of 8 months (4-24), were 67/90 (74.4%). In both studies, therapy was well tolerated.