INTRAVENOUS ANTI-D TREATMENT OF IMMUNE THROMBOCYTOPENIC PURPURA - EXPERIENCE IN 272 PATIENTS

We report the results of intravenous anti-D (WinRho, WinRho SD) therap y in 261 non-splenectomized patients treated at the New York Hospital- Cornell Medical Center over the period from 1987 to 1994. Children (n = 124) and adult patients (n = 137) with classic immune thrombocytopen ic purpura (ITP; n = 156) or human immunodeficiency virus (HIV) relate d thrombocytopenia (0 = 105) and acute (n = 75) or chronic (n = 186) d isease at the time of the initial anti-D treatment were studied. In ad dition, 11 previously splenectomized patients were treated as a separa te group. Our objectives were to evaluate the following. (1) Efficacy of anti-D: The response after the initial infusion was analyzed accord ing to clinical parameters, such as patient's age, HIV status, gender, disease duration, pretreatment platelet count, and hemoglobin value, as well as treatment-related factors, including the dose of anti-D, th e solvent detergent treatment of the preparation, and the type of admi nistration. (2) Use of anti-D as maintenance therapy: The duration of response after the initial infusion and the results of subsequent trea tments were evaluated. (3) Safety/toxicity of anti-D: Postinfusion rea ctions and hemoglobin decrease after treatment were studied. Anti-D is a safe treatment providing a hemostatic platelet increase in greater than 70% of the Rh+ non-splenectomized patients. The group with the be st results is HIV- children, but all patient groups respond and the ef fect lasts more than 21 days in 50% of the responders. Duration of res ponse is not influenced by HIV status; furthermore, HIV+ patients show no adverse effects on hemoglobin decrease or HIV disease progression. Patients with chronic ITP after splenectomy have minimal or no respon se to intravenous anti-D. (C) 1997 by The American Society of Hematolo gy.