Analysis for Spontaneous Remission of Chronic Immune Thrombocytopenic Purpura in Children

Jung, Tae Woong; Kwon, Dae Hyun; Jeong, Dae Chul; Koh, Dae Gyun

Abstract

BACKGROUND
Chronic immune thrombocytopenic purpura (chronic ITP) is the most common autoimmune disease for blood elements. Some patients recovered spontaneously during follow up of disease. We investigated the difference of related clinical parameters between spontaneous remission and no remission.
METHODS
We reviewed retrospectively medical records from January 1994 to December 2010. We analyzed clinical parameters such as age, sex, initial platelet count, response to initial treatment, maintenance therapy, and platelet counts at post-diagnosis with regular period in children with or without spontaneous remission.
RESULTS
This study was enrolled for 49 children with chronic ITP. Median age was 3.5 years (0.1-17.3). Male to female ratio was 1:1.9. Initial treatment with intravenous immunoglobulin was received in 36 children (73.3%). Spontaneous remission was shown in 23 children (46.9%) during study period with 4.4 year of median follow up. The relevant factors of remission were observed in younger age at diagnosis, maintenance therapy, and platelet counts at post-diagnosis 1 year, 2 years, 3 years (P<0.05). The most significant parameter for spontaneous remission was platelet count at post-diagnosis 6 months in Kaplan-Meier estimate (P=0.047, RR: 3.47, 95% CI: 1.03-24.04).
CONCLUSION
Spontaneous remission was shown in about half of patients with chronic ITP. This remission was related with younger age, maintenance therapy, and platelet count at post-diagnosis 6 months. These results suggest that regular follow up with maintenance therapy may be required for management of chronic ITP in children.