Pulsed high-dose dexamethasone therapy in children with chronic idiopathic thrombocytopenic purpura

Yasser A. Wali, Zakia A. Lamki, Wasifuddin Shah, Mathew Zacharia, Ahmed Hassan

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

The effectiveness of pulsed high-dose oral dexamethasone therapy in children with refractory chronic idiopathic thrombocytopenic purpura (ITP) is evaluated. Thirteen children with severe chronic ITP were enrolled in the study from an outpatient pediatric hematology clinic (ages 2-14 years), 5 boys and 7 girls. They did not maintain a response to other forms of therapy (IVIg, Anti-D, conventional steroids, danazol) and one girl relapsed after splenectomy. Dexamethasone was administered orally at a dosage of 40 mg/M2/day (maximum 40 mg/day) for 4 consecutive days. The cycle was repeated once a month for 6 months. The immediate response to therapy was excellent as the mean platelet count at day 1 was 15 × 109/L, while mean platelet count at day 4 was 158 × 109/L. At the end of 6 cycles 3 patients maintained a platelet count of >150 × 109/L and 4 patients showed partial response. At the end of the first year and second year (12 and 24 months after onset of treatment) 3 patients still had complete response, 3 patients had partial response, and 7 patients were failures. Six of the failures underwent splenectomy and one was shifted to dapsone, had no response, and refused splenectomy. Side effects were tolerable. They included bloating, nausea, vomiting, insomnia, anxiety, and depression, and transient glucosuria; however, they were not severe enough to discontinue the cycles. Mean duration of illness prior to start of dexamethasone was not significantly different in between responders and nonresponders. Dexamethasone given orally in high doses is an effective drug in achieving short-term platelet responses. Long-term remission is obtained in nearly half the patients with well-established chronic ITP. Its effectiveness in almost half the patients, minimal side effects, and low cost indicate that this treatment should be considered in patients with chronic ITP who do not tolerate the disease well before considering splenectomy.

Original languageEnglish
Pages (from-to)329-335
Number of pages7
JournalPediatric Hematology and Oncology
Volume19
Issue number5
DOIs
Publication statusPublished - 2002

Keywords

  • Chronic thrombocytopenia
  • Pulsed dexamethasone

ASJC Scopus subject areas

  • Cancer Research
  • Management of Technology and Innovation
  • Hematology
  • Oncology
  • Pediatrics, Perinatology, and Child Health

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