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Treatment of adult chronic autoimmune thrombocytopenic purpura with
repeated high-dose intravenous immunoglobulin
B Godeau, S Lesage, M Divine, V Wirquin, JP Farcet and P Bierling
Centre Departemental de Transfusion Sanguine, Hopital Henri Mondor,
Creteil, France.
Intravenous (i.v.) infusions of Ig concentrates are an effective but
expensive treatment for patients with autoimmune thrombocytopenic purpura
(AITP). The optimal treatment protocol and the long-term results are
uncertain, and the precise mechanism by which the platelet count increases
is poorly understood. Twenty adult patients with chronic AITP were enrolled
in a prospective study to compare the respective efficacy of two high-dose
IVIgG induction regimens (1 g v 2 g/kg body weight) and the long-term
effect of six 1 g/kg body weight i.v. IgG reinfusions. An initial response
was observed in all 18 evaluable patients: the platelet count increased to
a mean value of 251 x 10(9)/L (range 72 to 836 x 10(9)/L) and the mean
pretreatment platelet count was multiplied by 14.6. No difference in
efficiency was observed between the two i.v. IgG dosages. The degree of the
platelet count increment correlated in both groups with the increase in the
clearance of antibody-coated red blood cells, measured by an isotopic
method, but not with the serum IgG elevation. Treatment was considered to
have failed in 11 patients, 90 days after the last i.v. IgG reinfusion
(D90), because the platelet counts were comparable with pretreatment
values. In contrast, a complete response was observed at D90 in five
patients (mean platelet count: 184 x 10(9)/L; range: 150 to 250 x 10(9)/L)
and a partial response at D90 was obtained in the remaining two patients
(platelet counts: 70 and 104 x 10(9)/L). Five of the 7 responders at D90
kept a platelet count above 50 x 10(9)/L during the entire follow-up period
(mean 33 months; range: 5 to 66) with no further treatment; unfortunately,
no clinical or biologic criteria were found to be predictive of the
long-term response. This study shows that an i.v. IgG infusion regimen of 1
g/kg body weight could safely replace the classical 2 g/kg body weight
dosage, at least in patients who do not have life-threatening
thrombocytopenia. Moreover, repeated i.v. IgG reinfusion could be an
alternative for AITP patients in whom splenectomy is contraindicated.
Volume 82,
Issue 5,
pp. 1415-1421,
09/01/1993
Copyright © 1993 by The American Society of Hematology
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