[Treatment of idiopathic thrombopenic purpura. Results obtained in a series of 219 cases]

Abstract

From 1971 to 1979, 219 patients with idiopathic thrombocytopenic purpura (ITP) were seen and all subjected to the same scheme of treatment. there were 150 adults and 69 children ( less than 15 years old), 140 were females and 79 males. At presentation, 152 had had symptoms for less than 3 months ("recent" ITP) and 67 could be immediately considered as chronic ITP (since they had had symptoms for more than 3 months). Whatever the duration of symptoms, corticosteroid therapy (1.5 to 2 mg/kg/day during 3 weeks) was first administered. At the end of the treatment, normal platelet count was achieved in 92.5% (136/147) of the "recent" ITP and 77% (51/66) of the chronic ITP. One year later, a complete remission was still evident in 65% (96/147) of the "recent" ITP but in only 14% (9/66) of the chronic ITP 3 of whom had died of hemorrhage. So the total number of patients with chronic ITP, non responders to prednisone therapy was 110. In 19 cases, the further progression was unknown and 16 patients were in partial remission. Splenectomy, indicated in 75 patients, was performed in only 64. After 2 weeks the platelet count was normal in 94% (60/64) of the patients. The success (platelets greater than 100 000/microliter) was pronounced, one year after splenectomy, in 86% (55/64) of them. A splenic sequestration of the radiolabelled platelets appeared to be the only positive prognostic factor. Of 15 patients treated with azathioprine (2.5 mg/kg/day) over a 1 to 5 year period, 8 have gone into remission and 7 failed to respond (2 died from hemorrhage). Excluding the 19 patients with an unknown progression, the results are finally as follows: remissions (or success): 84.5% (169/200), partial remission: 8% (16/200), complete failure: 7.5% (15/200) with 2.5% (5/200) of deaths directly related to the disease. A total of 75 patients have been followed for more than 5 years and 8 of them (11%) relapsed following 4 to 6 years of remission.