Blood, 1 May 2001, Vol. 97, No. 9, pp. 2533-2533
Treatment of adults with ITP: less may be
more
Idiopathic thrombocytopenic purpura (ITP) is a common
autoimmune disorder managed by hematologists often outside of tertiary care centers. Yet despite its relative commonness, its natural history
has not been studied systematically. Ironically, the paucity of studies
of ITP subtly supports the concept of its benign nature. In contrast to
patients with acute leukemia, patients with ITP are often managed in
the community, where data collection is difficult. Portielje and
colleagues (page 2549) follow 152 patients with ITP who were managed in
a consistent fashion. Their analysis of the outcome at 2 and 10 years
after diagnosis should give us comfort. Most patients (85%) achieved a
safe platelet count (above 30 000/µL) off all therapy, and these
patients had the same 10-year mortality as the general population. Nine
percent of the patients had severe and refractory disease, and their
overall mortality was 4.2%, with death caused equally by bleeding (the
disease itself) and by infection (often secondary to the treatment). A
further 6 percent of patients maintained a safe platelet count on
maintenance therapy. These investigators concluded that most patients
with ITP have a good outcome without excess morbidity or mortality.
Their study further supports the growing practice of avoiding
aggressive therapy in ITP patients with mild to moderate thrombocytopenia.
The study answers some questions but raises others. What is the
explanation of the surprisingly high rate (26%) of postoperative complications of splenectomy? I suspect that laparoscopy splenectomy will prove to have a lower morbidity. The study also confirms the
centrality of splenectomy as the current definitive treatment for ITP.
Portielje and colleagues demonstrate that 75% of splenectomy patients
were in remission at 2 years and 66% remained in remission at 10 years.
John G. Kelton
McMaster University
