To evaluate the long-term efficacy of high-dose dexamethasone (HD-DXM) treatment for immune thrombocytopenia (ITP), we retrospectively analysed 36 newly diagnosed ITP patients treated with HD-DXM as a first-line treatment. An initial response was obtained in 23 (63.9%) patients, including 11 with a complete response (CR) and 12 with a partial response (PR). Six months after HD-DXM treatment, 26 of 33 (78.8%) evaluable patients achieved objective responses, including 18 CR and 8 PR. Among 13 patients without initial response, very early increased platelet count within a week (VEIP) was observed in 7 patients, 5 (71.4%) of whom achieved a response at 6 months. In 29 patients who had available platelet count within a week, patients showing VEIP revealed longer survival than those who did not (p = 0.026). HD-DXM was an effective treatment for newly diagnosed ITP patients. VEIP after HD-DXM treatment initiation was associated with a long-term objective response in newly diagnosed ITP patients.

1.
Lambert
MP
,
Gernsheimer
TB
.
Clinical updates in adult immune thrombocytopenia
.
Blood
.
2017 May 25
;
129
(
21
):
2829
35
. .
2.
Cheng
Y
,
Wong
RS
,
Soo
YO
,
Chui
CH
,
Lau
FY
,
Chan
NP
,
Initial treatment of immune thrombocytopenic purpura with high-dose dexamethasone
.
N Engl J Med
.
2003 Aug 28
;
349
(
9
):
831
6
. .
3.
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 Dec
;
83
(
12
):
764
8
. .
4.
Mazzucconi
MG
,
Fazi
P
,
Bernasconi
S
,
De Rossi
G
,
Leone
G
,
Gugliotta
L
,
Therapy with high-dose dexamethasone (HD-DXM) in previously untreated patients affected by idiopathic thrombocytopenic purpura: a GIMEMA experience
.
Blood
.
2007 Feb 15
;
109
(
4
):
1401
7
. .
5.
Mashhadi
MA
,
Kaykhaei
MA
,
Sepehri
Z
,
Miri-Moghaddam
E
.
Single course of high dose dexamethasone is more effective than conventional prednisolone therapy in the treatment of primary newly diagnosed immune thrombocytopenia
.
Daru
.
2012 Aug 28
;
20
(
1
):
7
. .
6.
Sakamoto
K
,
Nakasone
H
,
Tsurumi
S
,
Sasaki
K
,
Mitani
K
,
Kida
M
,
Prednisone versus high-dose dexamethasone for untreated primary immune thrombocytopenia. A retrospective study of the Japan Hematology & Oncology Clinical Study Group
.
J Thromb Thrombolysis
.
2014 Apr
;
37
(
3
):
279
86
.
7.
Din
B
,
Wang
X
,
Shi
Y
,
Li
Y
.
Long-term effect of high-dose dexamethasone with or without low-dose dexamethasone maintenance in untreated immune thrombocytopenia
.
Acta Haematol
.
2015
;
133
(
1
):
124
8
. .
8.
Wei
Y
,
Ji
XB
,
Wang
YW
,
Wang
JX
,
Yang
EQ
,
Wang
ZC
,
High-dose dexamethasone vs prednisone for treatment of adult immune thrombocytopenia: a prospective multicenter randomized trial
.
Blood
.
2016 Jan 21
;
127
(
3
):
296
370
. .
9.
Rodeghiero
F
,
Stasi
R
,
Gernsheimer
T
,
Michel
M
,
Provan
D
,
Arnold
DM
,
Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group
.
Blood
.
2009 Mar 12
;
113
(
11
):
2386
93
. .
10.
Mithoowani
S
,
Gregory-Miller
K
,
Goy
J
,
Miller
MC
,
Wang
G
,
Noroozi
N
,
High-dose dexamethasone compared with prednisone for previously untreated primary immune thrombocytopenia: a systematic review and meta-analysis
.
Lancet Haematol
.
2016 Oct
;
3
(
10
):
e489
e96
. .
11.
Doobaree
IU
,
Nandigam
R
,
Bennett
D
,
Newland
A
,
Provan
D
.
Thromboembolism in adults with primary immune thrombocytopenia: a systematic literature review and meta-analysis
.
Eur J Haematol
.
2016 Oct
;
97
(
4
):
321
30
. .
12.
Audia
S
,
Mahévas
M
,
Samson
M
,
Godeau
B
,
Bonnotte
B
.
Pathogenesis of immune thrombocytopenia
.
Autoimmun Rev
.
2017 Jun
;
16
(
6
):
620
32
. .
13.
McKenzie
CG
,
Guo
L
,
Freedman
J
,
Semple
JW
.
Cellular immune dysfunction in immune thrombocytopenia (ITP)
.
Br J Haematol
.
2013 Oct
;
163
(
1
):
10
23
. .
14.
Wang
T
,
Zhao
H
,
Ren
H
,
Guo
J
,
Xu
M
,
Yang
R
,
Type 1 and type 2 T-cell profiles in idiopathic thrombocytopenic purpura
.
Haematologica
.
2005 Jul
;
90
(
7
):
914
23
.
15.
Zhang
J
,
Ma
D
,
Zhu
X
,
Qu
X
,
Ji
C
,
Hou
M
.
Elevated profile of Th17, Th1 and Tc1 cells in patients with immune thrombocytopenic purpura
.
Haematologica
.
2009
;
94
:
1326
9
. .
16.
Ji
L
,
Zhan
Y
,
Hua
F
,
Li
F
,
Zou
S
,
Wang
W
,
The ratio of Treg/Th17 cells correlates with the disease activity of primary immune thrombocytopenia
.
PLoS One
.
2012
;
7
(
12
):
e50909
. .
17.
Liu
Z
,
Wang
M
,
Zhou
S
,
Ma
J
,
Shi
Y
,
Peng
J
,
Pulsed high-dose dexamethasone modulates Th1-/Th2-chemokine imbalance in immune thrombocytopenia
.
J Transl Med
.
2016 Oct 24
;
14
(
1
):
301
. .
18.
Li
J
,
Wang
Z
,
Hu
S
,
Zhao
X
,
Cao
L
.
Correction of abnormal T cell subsets by high-dose dexamethasone in patients with chronic idiopathic thrombocytopenic purpura
.
Immunol Lett
.
2013 Jul–Aug
;
154
(
1–2
):
42
8
. .
19.
Zhan
Y
,
Zou
S
,
Hua
F
,
Li
F
,
Ji
L
,
Wang
W
,
High-dose dexamethasone modulates serum cytokine profile in patients with primary immune thrombocytopenia
.
Immunol Lett
.
2014 Jul
;
160
(
1
):
33
8
. .
20.
Li
Q
,
Zhang
L
,
Xia
R
,
Zeng
Q
,
Wang
Y
,
Xia
L
,
Plasma levels of interleukin 12 family cytokines and their relevant cytokines in adult patients with chronic immune thrombocytopenia before and after high-dose dexamethasome treatment
.
Med Princ Pract
.
2015
;
24
(
5
):
458
64
. .
21.
Li
X
,
Zhong
H
,
Bao
W
,
Boulad
N
,
Evangelista
J
,
Haider
MA
,
Defective regulatory B-cell compartment in patients with immune thrombocytopenia
.
Blood
.
2012 Oct 18
;
120
(
16
):
3318
25
. .
22.
Hua
F
,
Ji
L
,
Zhan
Y
,
Li
F
,
Zou
S
,
Wang
X
,
Pulsed high-dose dexamethasone improves interleukin 10 secretion by CD5+ B cells in patients with primary immune thrombocytopenia
.
J Clin Immunol
.
2012 Dec
;
32
(
6
):
1233
42
. .
23.
Hua
F
,
Ji
L
,
Zhan
Y
,
Li
F
,
Zou
S
,
Chen
L
,
Aberrant frequency of IL-10-producing B cells and its association with Treg/Th17 in adult primary immune thrombocytopenia patients
.
Biomed Res Int
.
2014
;
2014
:
571302
. .
24.
Kuhne
T
,
Freedman
J
,
Semple
JW
,
Doyle
J
,
Butchart
S
,
Blanchette
VS
.
Platelet and immune responses to oral cyclic dexamethasone therapy in childhood chronic immune thrombocytopenic purpura
.
J Pediatr
.
1997 Jan
;
130
(
1
):
17
24
.
25.
Feng
Q
,
Xu
M
,
Yu
YY
,
Hou
Y
,
Mi
X
,
Sun
YX
,
High-dose dexamethasone or all-trans-retinoic acid restores the balance of macrophages towards M2 in immune thrombocytopenia
.
J Thromb Haemost
.
2017 Sep
;
15
(
9
):
1845
58
. .
26.
Hou
Y
,
Feng
Q
,
Xu
M
,
Li
GS
,
Liu
XN
,
Sheng
Z
,
High-dose dexamethasone corrects impaired myeloid-derived suppressor cell function via Ets1 in immune thrombocytopenia
.
Blood
.
2016 Mar 24
;
127
(
12
):
1587
97
. .
27.
Shao
X
,
Wu
B
,
Cheng
L
,
Li
F
,
Zhan
Y
,
Liu
C
,
Distinct alterations of CD68(+)CD163(+) M2-like macrophages and myeloid-derived suppressor cells in newly diagnosed primary immune thrombocytopenia with or without CR after high-dose dexamethasone treatment
.
J Transl Med
.
2018 Mar 2
;
16
(
1
):
48
.
28.
Podda
GM
,
Fiorelli
EM
,
Birocchi
S
,
Rambaldi
B
,
Di Chio
MC
,
Casazza
G
,
Treatment of immune thrombocytopenia (ITP) secondary to malignancy: a systematic review
.
Platelets
.
2020 Sep
:
1
7
. .
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