Maintenance treatment of adults with chronic refractory immune
thrombocytopenic purpura using repeated intravenous infusions of
gammaglobulin [see comments]
JB Bussel, LC Pham, L Aledort and R Nachman
Department of Pediatrics and Medicine, New York Hospital/Cornell Medical
Center 10021.
Intravenous infusion of gammaglobulin (IVGG) has been extensively used in
the treatment of immune thrombocytopenic purpura (ITP) in adults to acutely
raise the platelet count but not as a maintenance therapy. This report
describes the maintenance treatment of adults with chronic ITP using
repeated infusions of 800 to 1,000 mg/kg of IVGG. Sixteen of 40 patients
were able to discontinue all therapy after receiving between one and 15
infusions. Five patients achieved remission and 11 other patients became
stable without therapy (SWT) maintaining a platelet count greater than
20,000/microL without bleeding. The average quantity of gammaglobulin
received for all patients was 606 g per patient. Of the 30 patients who
underwent but did not respond to splenectomy, 11 (37%) were able to
discontinue all therapy by either achieving remission (5) or becoming SWT
(6). None of the five patients who achieved remission did so after only the
initial therapy; all first received between one and 12 maintenance
infusions. The ten splenectomized patients who were unresponsive to IVGG
also failed to subsequently respond to conventional therapy including
immunosuppressive agents and androgens. No toxicity of IVGG was seen except
for postinfusion headaches. IVGG is an effective although expensive
maintenance therapy for adults with ITP and is useful in patients who have
not responded to splenectomy.
Volume 72,
Issue 1,
pp. 121-127,
07/01/1988
Copyright © 1988 by The American Society of Hematology
