kjh The Korean Journal of Hematology Korean J Hematol 1738-7949 2092-9129 Korean Society of Hematology 10.5045/kjh.2009.44.1.22 kjh-44-22 Original Article Initial Therapy with High-Dose Dexamethasone for Patients with Idiopathic Thrombocytopenic Purpura YoonJin AhM.D. 1 KimChan KyuM.D. 2 KimSe HyungM.D. 2 KimKyung HaM.D. 2 KimHyun JungM.D. 2 ParkSung KyuM.D. 2 LeeSang ChulM.D. 2 LeeNam SuM.D. 2 BaeSang ByungM.D. 2 LeeKyu TaekM.D. 2 WonJong HoM.D. 2 ParkHee SookM.D. 2 HongDae SikM.D. 2 Department of Internal Medicine, Bucheon, Korea Division of Hematology and Oncology, College of Medicine, Soonchunhyang University, Bucheon, Korea Correspondence to：Dae Sik Hong, M.D., Ph.D. Division of Hematology and Oncology, College of Medicine, Soonchunhyang University 1174, Jung-dong, Wonmi-gu, Bucheon 420-767, Korea Tel: ＋82-32-621-5184, Fax: ＋82-32-621-5016 E-mail: dshong@schbc.ac.kr 032009 20032009 441 2227 14042008 10032009 15032009 Copyright © 2009 Korean Society of Hematology 2009 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background

Corticosteroids have been widely used for treatingidiopathic thrombocytopenic purpura (ITP) as a first-line treatment. Several different pulsed high-dose dexamethasone therapies for adult ITP have been reported on. We assessed the effectiveness of a single course of high dose dexamethasone as first-line treatment for adult patients with ITP.

 Methods

The subjects of the study were previously untreated adult patients with newly diagnosed ITP and who had a platelet count of less than 20,000/μL or a platelet count less than 50,000/μL. High-dose dexamethasone at a dose of 40mg/day for four consecutive days was given orally. A response was defined as an increase in the platelet count of at least 30,000/μL and a platelet count of more than 50,000/μL by day 10 after the initial treatment. A sustained response was defined as a platelet count of more than 50,000/μL that was maintained for six months after the initial treatment.

 Results

Twenty two patients were eligible. The median platelet count before treatment was 19,000/μL. Seventeen patients (77%) among the 22 patients achieved an initial response by day 10: the mean platelet count 10 days after the initial treatment was 144,000/μL (range: 51,000 to 428,000/μL). Among the patients with a response, 4 (23.5%) had a sustained response, and the other 13 (76.5%) relapsed within six months. All the patients well tolerated the high-dose dexamethasone treatment.

 Conclusion

A single course of high-dose dexamethasone is effective as an initial treatment for adults ITP patients, although the response duration is short. To maintain the response, repeated high-dose dexamethasone treatment may be needed or other alternative therapies can be considered.

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Treatment protocol and results in 22 patients with newly diagnosed idiopathic thrombocytopenic purpura.

Comparison of clinical and laboratory variables between responder and unresponder∗†

Variable Responder (17 patients) Unresponder (5 patient) P-value
Age (yr) 36.59±16.2 59.20±22.1 0.065
Sex (no.)     0.781
Male 8 2  
Female 9 3  
Platelet count (per μL)†      
Pretreatment 20,000 14,000 0.969
Day 2 45,000 28,000 0.327
Day 3 77,000 39,000 0.005
Day 4 109,000 41,000 0.003
Day 10 144,000 11,000 0.001

Plus-minus values are means±SD,

Platelet counts are median.

Comparison of clinical and laboratory variables between sustained response and relapse among the 17 patients with an initial response∗

Variable Sustained response (4 patients) Relapse (13 patient) P value
Age (yr) 44.50±22.87 34.15±13.90 0.893
Sex (no.)     0.394
Male 2 6  
Female 2 2  
Platelet count (per μL)†
Pretreatment 26,500 18,000 0.720
Day 2 54,000 28,000 0.125
Day 3 113,500 63,000 0.079
Day 4 149,000 109,000 0.245
Day 10 191,000 115,000 0.236
Day 30 207,000 120,500 0.034

Plus-minus values are means±SD,

Platelet counts are median.