Clin Pediatr Hematol Oncol.  2018 Oct;25(2):102-107. 10.15264/cpho.2018.25.2.102.

The Efficacy of High Dose Dexamethasone Therapy in Children with Immune Thrombocytopenic Purpura

• Lee HO
• Chang SH
• Baek HJ
• Kim HS
• Park SM
• Shin MG
• Kook H

• KMID: 2435401
• DOI: http://doi.org/10.15264/cpho.2018.25.2.102

Abstract

BACKGROUND
Few studies of high dose dexamethasone (HD-DXM) therapy in children with immune thrombocytopenic purpura (ITP) have been reported. The purpose of this study is to investigate efficacy and safety of repeated HD-DXM therapy as second-line treatment of ITP in childhood.
METHODS
We retrospectively analyzed the medical records of patients < 18 years of age with primary ITP who received more than 2 cycles of HD-DXM therapy from May 2004 to January 2018. HD-DXM was given orally in 4-day pulses every 28 days as a 20-40 mg/1.73 m² daily dose.
RESULTS
A total of 26 patients (male, 19; female, 7) were enrolled and their median age was 6 years (range, 1-15). All patients had received previous treatment for ITP. A median 6 cycles (range, 2-19) of HD-DXM was given. On the beginning of HD-DXM therapy, three patients satisfied the criteria for newly diagnosed ITP, 16 for persistent ITP and 7 for chronic ITP. Relapse-free survival (RFS) of responders (n=9) after the last HD-DXM cycle was estimated to be 38.1±17.2%, lasting for a median 9.1 months (range, 5.6-46.2). According to response after the 2nd cycle, RFS of responders (n=13) was significantly higher than non-responders (23.1±11.7% vs. 7.7%±7.4%, P=0.001). The most common adverse event was irritability (30.8%), followed by fatigue (19.2%).
CONCLUSION
HD-DXM therapy in children was relatively tolerated and response after therapy was acceptable. More courses of HD-DXM may be feasible in responders after two cycles of HD-DXM.

Keyword

Immune thrombocytopenic purpura; High dose dexamethasone

MeSH Terms

Child*
Dexamethasone*
Fatigue
Female
Humans
Medical Records
Purpura, Thrombocytopenic, Idiopathic*
Retrospective Studies
Dexamethasone