PULSED HIGH-DOSE DEXAMETHASONE IN REFRACTORY CHRONIC IDIOPATHIC THROMBOCYTOPENIC PURPURA - A REPORT ON 10 CASES

We treated 10 patients who had chronic refractory idiopathic thrombocy topenic purpura (ITP) with high-dose dexamethasone (DXM, 40 mg/d for 4 sequential days every month). The interval from diagnosis ranged from 49 to 300 months, and patients had previously received a median of 5. 5 treatments (including splenectomy in nine cases). Median platelet co unt was 14 x 10(9)/l (range 6-26 x 10(9)/l) at the onset of DXM and ei ght patients had bleeding symptoms. Eight patients received at least t hree cycles of DXM. Five patients had a response (i.e. platelet count at least doubled and increased by >20 x 10(9)/l), including one almost complete remission and four minor responses (MR). Of the MR, one was probably due to concurrent IVIg administration, and all four MR were t ransient, in spite of further cycles of DXM. In three patients DXM was a failure after three or four cycles. In two patients DXM had to be s topped after one course because of major side-effects (systemic hypert ension with stroke and insulin-dependent diabetes, respectively). In o ur experience, high-dose DXM had a relatively limited effect in chroni c refractory ITP and was associated with severe side-effects in some c ases.