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Blood, 15 November 2007, Vol. 110, No. 10, pp. 3526-3531. Prepublished online as a Blood First Edition Paper on August 13, 2007; DOI 10.1182/blood-2007-01-065763. This Article Full Text Full Text (PDF) All Versions of this Article: blood-2007-01-065763v1 110/10/3526    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Boruchov, D. M. Articles by Bussel, J. B. Search for Related Content PubMed PubMed Citation Articles by Boruchov, D. M. Articles by Bussel, J. B. Related Collections Hemostasis, Thrombosis, and Vascular Biology Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS Multiagent induction and maintenance therapy for patients with refractory immune thrombocytopenic purpura (ITP) Donna M. Boruchov1, Sri Gururangan2, M. Catherine Driscoll3, and James B. Bussel4 1 The Brookdale University Hospital and Medical Center Department of Pediatrics, Hematology Oncology, Brooklyn, NY; 2 The Preston Robert Tisch Brain Tumor Center and the Departments of Pediatrics and Surgery, Duke University Medical Center, Durham, NC; 3 Children's National Medical Center, Department of Hematology-Oncology, Washington, DC; and 4 Weill Medical College of Cornell University Division of Pediatric Hematology Oncology, New York, NY Patients with severe immune thrombocytopenic purpura (ITP) may require an acute increase in the platelet count for surgery or ongoing hemorrhage as well as long-term maintenance treatment. Certain of these patients may be refractory to steroids, intravenous anti-D, intravenous immunoglobulin (IVIG), and splenectomy. Therefore, acute platelet increases were studied in 35 patients completely unresponsive to IVIG or high-dose steroid treatment. Because of their lack of response to either or both single agents, these patients were administered a 3- or 4-drug combination including IVIG 1 g/kg, intravenous methylprednisolone 30 mg/kg, Vinca alkaloids (VCR 0.03 mg/kg), and/or intravenous anti-D (50-75 µg/kg). Subsequent maintenance therapy with the oral combination of danazol (10-15 mg/kg) and azathioprine (2 mg/kg) was given to 18 of the 35 patients. Seventy-one percent of the patients responded to the intravenous combination treatment with acute platelet increases of at least 20x109/L to a level greater than 30x109/L. Two thirds of the patients given maintenance therapy achieved stable platelet counts greater than 50x109/L without other treatments. One patient developed an ileus, but otherwise there was little toxicity of combination treatment. Combination chemotherapy is a useful approach for patients with ITP refractory to conventional treatments both for acute induction and for long-term maintenance therapy. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: D. Provan, R. Stasi, A. C. Newland, V. S. Blanchette, P. Bolton-Maggs, J. B. Bussel, B. H. Chong, D. B. Cines, T. B. Gernsheimer, B. Godeau, et al. International consensus report on the investigation and management of primary immune thrombocytopenia Blood, January 14, 2010; 115(2): 168 - 186. [Abstract] [Full Text] [PDF] D. M. Arnold, I. Nazi, A. Santos, H. Chan, N. M. Heddle, T. E. Warkentin, and J. G. Kelton Combination immunosuppressant therapy for patients with chronic refractory immune thrombocytopenic purpura Blood, January 7, 2010; 115(1): 29 - 31. [Abstract] [Full Text] [PDF] B. Psaila, A. Petrovic, L. K. Page, J. Menell, M. Schonholz, and J. B. Bussel Intracranial hemorrhage (ICH) in children with immune thrombocytopenia (ITP): study of 40 cases Blood, November 26, 2009; 114(23): 4777 - 4783. [Abstract] [Full Text] [PDF] F. Rodeghiero, R. Stasi, T. Gernsheimer, M. Michel, D. Provan, D. M. Arnold, J. B. Bussel, D. B. Cines, B. H. Chong, N. Cooper, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group Blood, March 12, 2009; 113(11): 2386 - 2393. [Abstract] [Full Text] [PDF] G. Emilia, M. Luppi, M. Morselli, F. Forghieri, L. Potenza, and G. Torelli A possible role for low-dose cyclosporine in refractory immune thrombocytopenic purpura Haematologica, July 1, 2008; 93(7): 1113 - 1115. [Full Text] [PDF] Refractory Immune Thrombocytopenic Purpura Journal Watch Oncology and Hematology, December 18, 2007; 2007(1218): 2 - 2. [Full Text]

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