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Blood, 15 March 2002, Vol. 99, No. 6, pp. 1922-1927
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Does treatment with intermittent infusions of intravenous anti-D
allow a proportion of adults with recently diagnosed immune
thrombocytopenic purpura to avoid splenectomy?
Nichola Cooper,
B. Michael
R. Woloski,
Erin M. Fodero,
Maria Novoa,
Melissa Leber,
Juerg H. Beer, and
James B. Bussel
From the Division of Hematology/Oncology, Department of
Pediatrics, New York Presbyterian Hospital Weill Medical College of
Cornell University, NY; Cangene, Winnipeg, Canada; and Kantonsspital,
Baden, Switzerland.
This study explored whether repeated infusions of intravenous
anti-D could allow adults with recently diagnosed immune
thrombocytopenic purpura (ITP) who had failed an initial steroid course
to postpone and ultimately avoid splenectomy. Twenty-eight
Rh+, nonsplenectomized adults with ITP diagnosed within 1 to 11 months and platelet counts 30 × 109/L
(30 000/µL) or below were enrolled. Anti-D was infused
whenever the platelet count decreased to 30 × 109/L
(30 000/µL) or below. "Response" was defined as a platelet increase of more than 20 × 109/L (20 000/µL)
to more than 30 × 109/L (30 000/µL) within 7 days of
treatment. Patients were a median 3.5 months from ITP diagnosis at
enrollment and had received a median of 2 previous therapies, including
prednisone in 26 of 28 cases. They were followed for a median 26 months. A total of 93% responded to their initial infusion of anti-D,
and 68% repeatedly responded with counts maintained above
30 × 109/L (30 000/µL) using anti-D alone. Currently,
12 (43%) of 28 patients have been off all treatment for more than 6 months without undergoing splenectomy, 6 maintaining counts above
100 × 109/L (100 000/µL). Seven continue on
treatment, 8 underwent splenectomy, and 1 was lost to follow-up at 10 months. One patient discontinued anti-D because of toxicity. Patients
with platelet counts at least 14 × 109/L (14 000/µL)
at enrollment were more likely to discontinue treatment (P < .05). Anti-D was an effective maintenance treatment
for two thirds of Rh+, nonsplenectomized adults with ITP
who had failed an initial steroid course. Intermittent infusions of
intravenous anti-D allowed more than 40% of these adults to avoid
splenectomy and to achieve stable platelet counts off all therapy, even
after many months of treatment. Platelet count at study entry was the
primary predictor of outcome.
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