Clinical Efficacy of Combined Immunosuppressant Therapy on Chronic Refractory Immune Thrombocytopenia Purpura and Its Effects on the Level of Platelete-associated antibody_West China Medical Journal

Authors：

 XIEXiao-ying ¹ , GUOYong ² ,  XIANGBing ²

1. Department of Hematology, the First People's Hospital of Yi Autonomous Prefecture of Liangshan, Xichang, Sichuan 615000, P. R. China;
2. Department of Hematology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

XIANGBing, Email: xiang7199@hotmail.com

Keywords：

Immunosuppressant; Platelet-associated antibody; Immune thrombocytopenia purpura

DOI：

10.7507/1002-0179.20140186

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To observe the clinical efficacy of combined immunosuppressant therapy for patients with chronic refractory immune thrombocytopenia purpura (ITP) and its effects on platelete-associated antibody (PAIG) level. Methods Between February 2009 and February 2013, 22 patients with refractory ITP were randomly divided into immunosuppressive drugs combination treatment group and single drug treatment group. The combination treatment group was treated with methylprednisolone and intravenous immunoglobulin (IVIG), and after the fast increasing of platelet count, combined chemotherapy consisting of two or three kinds of immunosuppressive agents was adopted. The single treatment group was also treated with methylprednisolone and IVIG, but took only one immunosuppressive agent after the fast increasing of platelet count. The treatment maintained for 3 to 6 months. The duration of follow-up was 6-36 months. We used flow cytometry to detect PAIG of the patients. Results The total effective rate of combination treatment group was 81.8%, significantly higher than that of the single treatment group (36.4%) (P<0.05). PAIG decreased obviously in both the two groups, and the PAIG level of the combination treatment group was much lower than that of the single treatment group (P<0.05). Conclusion Immunosuppresant combination chemotherapy is a powerful approach for patients with refractory ITP, and it can decrease patient's PAIG level simultaneously.

Citation： XIEXiao-ying, GUOYong, XIANGBing. Clinical Efficacy of Combined Immunosuppressant Therapy on Chronic Refractory Immune Thrombocytopenia Purpura and Its Effects on the Level of Platelete-associated antibody. West China Medical Journal, 2014, 29(4): 616-619. doi: 10.7507/1002-0179.20140186 Copy

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13.	Contis A, Lazaro E, Greib C, et al. Romiplostim as early treatment for refractory primary immune thrombocytopenia[J]. Int J Hematol, 2013, 98(5):520-524.
14.	Iványi JL, Marton E, Plander M. Treatment outcome of immune thrombocytopenia[J]. Orv Hetil, 2012, 153(41):1613-1621.
15.	Vilaplana VE, Aragonés JH, Fernández-Llamazares CM, et al. Use of romiplostim for primary immune thrombocytopenia in children[J]. Pediatr Hematol Oncol, 2012, 29(2):197-205.
16.	Lo E, Deane S. Diagnosis and classification of immune-mediated thrombocytopenia[J]. Autoimmun Rev, 2014, 13(4/5):577-583.
17.	Schipperus M, Fijnheer R. New therapeutic options for immune thrombocytopenia[J]. Neth J Med, 2011, 69(11):480-485.

1. Cines DB, Liebman H, Stasi R. Pathobiology of secondary immune thrombocytopenia[J]. Semin Hematol, 2009, 46(1 Suppl 2):S2-14.
2. Lev PR, Grodzielski M, Goette NP, et al. Impaired proplatelet formation in immune thrombocytopenia:a novel mechanism contributing to decreased platelet count[J/OL]. Br J Haematol, (2014-03-27). http://www.ncbi.nlm.nih.gov/pubmed/24673454.
3. Yehudai D, Toubi E, Shoenfeld Y, et al. Autoimmunity and novel therapies in immune-mediated thrombocytopenia[J]. Semin Hematol, 2013, 50(Suppl 1):S100-S108.
4. Boruchov DM, Gururangan S, Driscoll MC, et al. Multiagent induction and maintenance therapy for patients with refractory immune thrombocytopenic purpura (ITP)[J]. Blood, 2007, 110(10):3526-3531.
5. 中华医学会血液分会血栓与止血学组. 成人原发免疫性血小板减少症诊治中国专家共识(修订版)[J]. 中华血液学杂志, 2011, 32(3):218-219.
6. 张之南, 沈悌. 血液病诊断及疗效标准[M]. 3版. 北京:科学出版社, 2007:172-175.
7. Kashiwagi H, Tomiyama Y. Pathophysiology and management of primary immune thrombocytopenia[J]. Int J Hematol, 2013, 98(1):24-33.
8. Johnsen J. Pathogenesis in immune thrombocytopenia:new insights[J]. Hematology Am Soc Hematol Educ Program, 2012, 2012(1):306-312.
9. Ghanima W, Godeau B, Cines DB, et al. How I treat immune thrombocytopenia:the choice between splenectomy or a medical therapy as a second-line treatment[J]. Blood, 2012, 120(5):960-969.
10. Mcmillan R, Durette C. Long-term outcomes in adults with chronic ITP after splenectomy failure[J]. Blood, 2004, 104(4):956-960.
11. Portielje JE, Westendorp RG, Kluin-Nelemans HC, et al. Morbidity and mortality in adults with idiopathic thrombocytopenic purpura[J]. Blood, 2001, 97(9):2549-2554.
12. Tun NM, Villani GM. Efficacy of rituximab in acute refractory or chronic relapsing non-familial idiopathic thrombotic thrombocytopenic purpura:a systematic review with pooled data analysis[J]. J Thromb Thrombolysis, 2012, 34(3):347-359.
13. Contis A, Lazaro E, Greib C, et al. Romiplostim as early treatment for refractory primary immune thrombocytopenia[J]. Int J Hematol, 2013, 98(5):520-524.
14. Iványi JL, Marton E, Plander M. Treatment outcome of immune thrombocytopenia[J]. Orv Hetil, 2012, 153(41):1613-1621.
15. Vilaplana VE, Aragonés JH, Fernández-Llamazares CM, et al. Use of romiplostim for primary immune thrombocytopenia in children[J]. Pediatr Hematol Oncol, 2012, 29(2):197-205.
16. Lo E, Deane S. Diagnosis and classification of immune-mediated thrombocytopenia[J]. Autoimmun Rev, 2014, 13(4/5):577-583.
17. Schipperus M, Fijnheer R. New therapeutic options for immune thrombocytopenia[J]. Neth J Med, 2011, 69(11):480-485.

West China Medical Journal

Clinical Efficacy of Combined Immunosuppressant Therapy on Chronic Refractory Immune Thrombocytopenia Purpura and Its Effects on the Level of Platelete-associated antibody

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