Combination immunosuppressant therapy for patients with chronic refractory immune thrombocytopenia

Objective To observe the clinic effects and safety of combination immunosuppressant therapy for patients with chronic refractory immune thrombocytopenia(ITP).Methods 37 patients with refractory ITP were randomly divided into treatment group(17 patients) and control group(20 patients).The control group was treated with methylprednisolone1g/d and IVIG0.4g/kg/d for 3~5 days,then took prednisone 1mg/kg/d orally for 2 weeks to become gradually reduced to maintenance.The treatments were administrated with a 2-or3-drug intravenous combination immunosuppressant including methylprednisolone 1g/d,IVIG0.4g/kg/d,Vinca alkaloids 2mg/d Methylprednisolone 1g/d to rapidly increase the platelet count,then given a 2-or3-drug oral maintenance treatment with danazol 200mg bid,cyclosporine 50mg bid and mycophenolate mofetil 1g bid.The oral treatment maintained for 3~6 months.The duration of follow-up was 36 months.Results The total effect rate in treatment group and control group was 88.2% and 55.0% respectively,and the difference was significant(P0.01).TThe platelet average of treatment group was higher than that of the control group(99.823×109/L vs 22.350×109/L,P=0.00).The average maintenance time of platelet count were 19.117monthes and 15.000monthes,and the differences were significant(P0.01).Treatments were well tolerated,none had serious complication.Conclusion Combination chemotherapy is a useful approach for patients with refractory ITP which could maintain a long-term safe platelet count.