Therapeutic experience on 934 adults with idiopathic thrombocytopenic purpura: Multicentric Trial of the Cooperative Latin American group on Hemostasis and Thrombosis

Abstract

In order to analyze the usefulness of different types of treatment in relation to the interval since the onset of idiopathic thrombocytopenic purpura (ITP), a collaborative study of 934 adult patients was undertaken. Prednisone was administered to 818 patients, and 32% of them achieved prolonged complete remission (PCR). However, only 14% of patients who had ITP for more than six months achieved a prednisone- induced PCR (P less than .01). Splenectomy was done in 399 patients, and 65% of them achieved PCR; the remission rate did not vary with the interval since the onset of ITP. Of 120 patients with chronic ITP that was refractory to corticosteroids and splenectomy, 91 received either azathioprine or cyclophosphamide; 21% of them achieved PCR and 55% had a favorable response. None of 19 patients treated with vincristine and only one of ten patients treated with vinblastine-loaded platelets achieved PCR.

Clinically significant newly presenting autoimmune thrombocytopenic purpura in adults: a prospective study of a population‐based cohort of 245 patients

“…In the present study, the death rate from causes directly related to ITP or its treatment was 1AE6% with only one patient dying at presentation. This would be in keeping with the experience of others (Watson-Williams et al, 1958;Doan & Bouroncle, 1960;Thompson et al, 1972;JiJi et al, 1973;DiFino et al, 1980;Picozzi et al, 1980;Pizzuto & Ambriz, 1984;Cortelazzo et al, 1991;Portielje et al, 2001) where the reported incidence was 0-5%.…”

“…The total number of patients progressing to splenectomy was 12% (see Table III). This is lower than in the literature (28-88%, see Table VII) (Watson-Williams et al, 1958;Doan & Bouroncle, 1960;Thompson et al, 1972;JiJi et al, 1973;DiFino et al, 1980;Picozzi et al, 1980;Pizzuto & Ambriz, 1984;Jacobs & Wood, 1986;Cortelazzo et al, 1991;Portielje et al, 2001) and may reflect a more selected group of patients in other studies.…”

“…ITP is generally reported to be commoner in women than in men, and this is supported by numerous reports in the literature (Watson-Williams et al, 1958;Doan & Bouroncle, 1960;Thompson et al, 1972;DiFino et al, 1980;Pizzuto & Ambriz, 1984;Jacobs & Wood, 1986;Cortelazzo et al, 1991;Kaufman et al, 1993;George et al, 1995;Portielje et al, 2001;Godeau et al, 2002) (see Table VII). The present study, which is population based, found that, although the absolute majority of patients presenting with ITP are women, when the population at risk is taken into account, the age/gender-specific incidence is similar (see Fig 1).…”

Immune thrombocytopenia: Effectiveness of frontline steroids and comparison of azathioprine, splenectomy, and rituximab as second‐line treatment

“…The response rate of azathioprine is higher than previous studies, which reported complete response rates of 20%-45%. [29][30][31] It may result from difference in case enrollment and definition of response. As the baseline conditions of these two treatment groups are not balanced in such a retrospective study, the outcome should not be compared with each other in an objective analysis.…”

First‐line therapies for immune thrombocytopenic purpura: re‐evaluating the need to treat

“…The overall mortality rates in ITP have been estimated in more than a dozen studies, and they vary from 0.1% to as much as 5.0% (Table 1) (6,7). Mortality rates do increase with age, and age-adjusted bleeding risks estimated by meta-analysis are 0.004, 0.012, and 0.130 cases per patient-year for age groups younger than 40, 40-60, and older than 60 yr, respectively (8).…”