Emilia Parodi1, Paola Giordano2, Elisa Rivetti3, Maria Teresa Giraudo4, Giulia Ansaldi3, Mirella Davitto3, Anna Mondino3, Piero Farruggia5, Giovanni Amendola6, Sofia M R Matarese7, Francesca Rossi7, Giovanna Russo8, Ugo Ramenghi3. 1. Paediatric and Neonatology Unit, Ordine Mauriziano Hospital, Torino, Italy Haematology Unit, Department of Paediatric Sciences, University of Turin, Turin, Italy. 2. Department of Biomedicine of the Developmental Age, Paediatric Unit, University of Bari, Bari, Italy. 3. Haematology Unit, Department of Paediatric Sciences, University of Turin, Turin, Italy. 4. Department of Mathematics, University of Turin, Turin, Italy. 5. Oncology Department, Paediatric Haematology and Oncology Unit, A.R.N.A.S. Ospedale Civico Di Cristina e Benefratelli, Palermo, Italy. 6. Paediatric Unit, Umberto I Hospital, Nocera Inferiore, Italy. 7. Paediatric Department, II University of Naples, Naples, Italy. 8. Paediatric Department, University of Catania, Catania, Italy.
Abstract
BACKGROUND: The aim of this study was to investigate the effect of the combined administration of intravenous immunoglobulins and steroids as a second-line therapy in 34 children with primary immune thrombocytopenia and persistent, symptomatic bleeding. MATERIALS AND METHODS: Combined therapy (intravenous immunoglobulins 0.4 g/kg daily on days 1 and 2, and methylprednisolone 20 mg/kg daily on days 1-3) was administered to 12 patients with newly diagnosed ITP who did not respond to the administration of a single therapy (either intravenous immunoglobulins or steroids) and to 22 children with persistent and chronic disease who required frequent administrations (i.e. more frequently than every 30 days) of either immunoglobulins or steroids (at the same standard dosages) in order to control active bleeding. RESULTS: A response (i.e. platelet count >50×10(9)/L and remission of active bleeding) was observed in 8/12 (67%) patients with newly diagnosed ITP. The clinical presentation of responders and non-responders did not differ apparently. Patients in the chronic/persistent phase of disease had a significantly longer median period of remission from symptoms compared with the previous longest period of remission (p=0.016). The treatment was well tolerated. DISCUSSION: Our data suggest that the combined approach described is a well-tolerated therapeutic option for children with primary immune thrombocytopenia and persistent bleeding symptoms that can be used in both emergency and/or maintenance settings.
BACKGROUND: The aim of this study was to investigate the effect of the combined administration of intravenous immunoglobulins and steroids as a second-line therapy in 34 children with primary immune thrombocytopenia and persistent, symptomatic bleeding. MATERIALS AND METHODS: Combined therapy (intravenous immunoglobulins 0.4 g/kg daily on days 1 and 2, and methylprednisolone 20 mg/kg daily on days 1-3) was administered to 12 patients with newly diagnosed ITP who did not respond to the administration of a single therapy (either intravenous immunoglobulins or steroids) and to 22 children with persistent and chronic disease who required frequent administrations (i.e. more frequently than every 30 days) of either immunoglobulins or steroids (at the same standard dosages) in order to control active bleeding. RESULTS: A response (i.e. platelet count >50×10(9)/L and remission of active bleeding) was observed in 8/12 (67%) patients with newly diagnosed ITP. The clinical presentation of responders and non-responders did not differ apparently. Patients in the chronic/persistent phase of disease had a significantly longer median period of remission from symptoms compared with the previous longest period of remission (p=0.016). The treatment was well tolerated. DISCUSSION: Our data suggest that the combined approach described is a well-tolerated therapeutic option for children with primary immune thrombocytopenia and persistent bleeding symptoms that can be used in both emergency and/or maintenance settings.
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