TRANSIENT-RESPONSE TO MULTIPLE COURSES OF PULSE HIGH-DOSE DEXAMETHASONE THERAPY IN CHILDREN WITH IDIOPATHIC THROMBOCYTOPENIC PURPURA

Childhood idiopathic thrombocytopenic purpura (ITP) is usually a trans ient disorder that resolves in 80 to 90% of patients within 6 months [ 1]. Patients with thrombocytopenia persisting beyond 6 months are defi ned as having chronic ITP. Chronic ITP occurs more often in females, i n children over 10 years of age and in those patients with a family hi story of ITP or other autoimmune disorders. Therapeutic interventions include corticosteroids [2-4], intravenous immunoglobulin [3, 4] and a nti-D [4, 5], Other chronic therapies such as cyclophosphamide, azathi oprine, vinca alkaloids, colchicine, danazol, interferon and cyclospor ine are usually reserved for refractory adult patients [6]. Recently, short pulses of high-dose dexamethasone therapy have been shown to ind uce durable responses with minimal side-effects in adults [7], Such an approach has been shown to be efficacious in acutely raising the plat elet count as short term therapy in children [8], and very recently tw o studies in children with chronic ITP examined the response to up to six courses of high-dose decadron therapy [9, 10], Our objective was t o treat children who had either chronic ITP or recurrent symptomatic t hrombocytopenia after one or more courses of intravenous gamma globuli n with multiple pulses of high-dose dexamethasone therapy in an attemp t to induce remission or delay splenectomy.