Background: To tackle the problems associated with high-dose dexamethasone (HD-DXM) in patients with immune thrombocytopenia (ITP). Aim: To compare the efficacy of HD-DXM with or without low-dose dexamethasone maintenance in untreated ITP patients. Results: Dexamethasone (40 mg/day) was given in 4-day pulses every 14 days for 3 cycles in 61 patients with ITP. Among them, 30 cases were given dexamethasone (0.035 mg/kg per day) for maintenance between pulsed HD-DXM and after 3 HD-DXM courses (HD-DXM-M group) and another 31 cases did not receive dexamethasone maintenance (HD-DXM-nM group). The control group comprised the patients who received prednisone (prednisone group). The following results were obtained: (1) at the end of the 3rd cycle, the overall response rate (ORR) was higher in the HD-DXM group than in the prednisone group; (2) the ORR of the HD-DXM group peaked after the 3rd cycle; (3) the ORR after each course was higher in the HD-DXM-M group than in the HD-DXM-nM group; (4) in the 12th month after HD-DXM discontinuation, the relapse rate of the HD-DXM-M group was lower than that of the other groups (prednisone and HD-DXM-nM). Conclusion: Treatment with 3 cycles of HD-DXM pulses with low-dose dexamethasone maintenance is an effective method for untreated ITP.

1.
McFarand J: Pathophysiology of platelet destruction in immune (idiopathic) thrombocytopenic purpura. Blood Rev 2002;16:1-2.
2.
Portielje JE, Westendorp RG, Kluin-Nelemans HC, Brand A: Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood 2001;97:2549-2554.
3.
Wang T, Zhao H, Ren H, Guo J, Xu M, Yang R, Han ZC: Type 1 and type 2 T-cell profiles in idiopathic thrombocytopenic purpura. Haematologica 2005;90:914-923.
4.
Cheng Y, Wong RS, Soo YO, Chui CH, Lau FY, Chan NP, Wong WS, Cheng G: Initial treatment of immune thrombocytopenic purpura with high-dose dexamethasone. N Engl J Med 2003;349:831-836.
5.
Borst F, Keuning JJ, van Hulsteijn H, Sinnige H, Vreugdenhil G: High-dose dexamethasone as a first- and second-line treatment of idiopathic thrombocytopenic purpura in adults. Ann Hematol 2004;83:764-768.
6.
Mazzucconi MG, Fazi P, Bernasconi S, De Rossi G, Leone G, Gugliotta L, Vianelli N, Avvisati G, Rodeghiero F, Amendola A, Baronci C, Carbone C, Quattrin S, Fioritoni G, D'Alfonso G, Mandelli F; Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA) Thrombocytopenia Working Party: Therapy with high-dose dexamethasone (HD-DXM) in previously untreated patients affected by idiopathic thrombocytopenic purpura: a GIMEMA experience. Blood 2007;109:1401-1407.
7.
Andersen JC: Response of resistant idiopathic thrombocytopenic purpura to pulsed high-dose dexamethasone therapy. N Engl J Med 1994;330:1560-1564.
8.
Warner M, Wasi P, Couban S, Hayward C, Warkentin T, Kelton JG: Failure of pulse high-dose dexamethasone in chronic idiopathic immune thrombocytopenia. Am J Hematol 1997;54:267-270.
9.
Gutiérrez-Espíndola GR, Morales-Polanco MR, Guerrero-Rivera S, Talavera JO, Sánchez-Valle E, Gómez-Morales E, Gómez-Morales E, Pizzuto-Chávez J: High doses of dexamethasone in adult patients with idiopathic thrombocytopenic purpura. Arch Med Res 2003;34:31-34.
10.
Stasi R, Brunetti M, Pagano A, Stipa E, Masi M, Amadori S: Pulsed intravenous high-dose dexamethasone in adults with chronic idiopathic thrombocytopenic purpura. Blood Cells Mol Dis 2000;26:582-586.
11.
Wali YA, Al Lamki Z, Shah W, Zacharia M, Hassan A: Pulsed high-dose dexamethasone therapy in children with chronic idiopathic thrombocytopenic purpura. Pediatr Hematol Oncol 2002;19:329-335.
12.
Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, Bussel JB, Cines DB, Chong BH, Cooper N, Godeau B, Lechner K, Mazzucconi MG, McMillan R, Sanz MA, Imbach P, Blanchette V, Kühne T, Ruggeri M, George JN: Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 2009;113:2386-2393.
13.
National Cancer Institute: Common Toxicity Criteria version 3.0. (CTCAE v3.0). 2003, http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcaev3.pdf.
14.
Buchanan GR, Adix L: Grading of hemorrhage in children with idiopathic thrombocytopenic purpura. J Pediatr 2002;141:683-688.
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