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Original Article
The Efficacy of High Dose Dexamethasone Therapy in Children with Immune Thrombocytopenic Purpura
Clin Pediatr Hematol Oncol 2018;25:102-7.
Published online October 31, 2018
© 2018 Korean Society of Pediatric Hematology-Oncology and Korean Society for Pediatric Neuro-Oncology

Hyun Ok Lee, M.D.1, Seong Hwan Chang, M.D.1, Hee Jo Baek, M.D., Ph.D.1, Ho Sung Kim, M.D.1, Su Min Park, M.D.1, Myung Geun Shin, M.D.2 and Hoon Kook, M.D.1

Departments of 1Pediatrics and 2Laboratory Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
Correspondence to: Hee Jo Baek
Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun 58128, Korea
Tel: +82-61-379-7695
Fax: +82-61-379-7697
E-mail: swan93@naver.com
ORCID ID: orcid.org/0000-0003-3830-8134
Received September 24, 2018; Revised September 26, 2018; Accepted October 10, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Few studies of high dose dexamethasone (HD-DXM) therapy in children with immune thrombocytopenic purpura (ITP) have been reported. The purpose of this study is to investigate efficacy and safety of repeated HD-DXM therapy as second-line treatment of ITP in childhood.
Methods: We retrospectively analyzed the medical records of patients <18 years of age with primary ITP who received more than 2 cycles of HD-DXM therapy from May 2004 to January 2018. HD-DXM was given orally in 4-day pulses every 28 days as a 20-40 mg/1.73 m2 daily dose.
Results: A total of 26 patients (male, 19; female, 7) were enrolled and their median age was 6 years (range, 1-15). All patients had received previous treatment for ITP. A median 6 cycles (range, 2-19) of HD-DXM was given. On the beginning of HD-DXM therapy, three patients satisfied the criteria for newly diagnosed ITP, 16 for persistent ITP and 7 for chronic ITP. Relapse-free survival (RFS) of responders (n=9) after the last HD-DXM cycle was estimated to be 38.1±17.2%, lasting for a median 9.1 months (range, 5.6-46.2). According to response after the 2nd cycle, RFS of responders (n=13) was significantly higher than non-responders (23.1±11.7% vs. 7.7%±7.4%, P=0.001). The most common adverse event was irritability (30.8%), followed by fatigue (19.2%).
Conclusion: HD-DXM therapy in children was relatively tolerated and response after therapy was acceptable. More courses of HD-DXM may be feasible in responders after two cycles of HD-DXM.
Keywords: Immune thrombocytopenic purpura, High dose dexamethasone


October 2018, 25 (2)
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  • Hee Jo Baek