Difference between revisions of "Immune thrombocytopenia"

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(Created page with "'''Use of this site is subject to you reading and agreeing with the terms set forth in the disclaimer.''' Is ...")
 
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{{TOC limit|limit=3}}
 
{{TOC limit|limit=3}}
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=Initial therapy=
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==Dexamethasone, high-dose==
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===Regimen #1, Cheng, et al. 2003===
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[[Levels of Evidence]]:
 +
<span
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style="background:#EEEE00;
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padding:3px 6px 3px 6px;
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border-color:black;
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border-width:2px;
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border-style:solid;">125 patients enrolled</span>
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*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1 to 4
 +
 +
'''4-day course'''; patients who had an initial response, but whose platelets dropped below 30,000 within 6 months received:
 +
 +
*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1 to 4
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*[[Prednisone (Sterapred)]] 15 mg PO once per day starting on day 5, "with gradual tapering"
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 +
===Regimen #2, Mazzucconi, et al. 2007 (monthly dexamethasone)===
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[[Levels of Evidence]]:
 +
<span
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style="background:#EEEE00;
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padding:3px 6px 3px 6px;
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border-color:black;
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border-width:2px;
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border-style:solid;">37 patients</span>
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*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1 to 4
 +
*Patients who had platelet counts of ≤20 x 10<sup>9</sup>/L between cycles received [[Prednisone (Sterapred)]] 0.25 mg/kg PO once per day "between courses"
 +
 +
'''28-day cycles x 6 cycles'''
 +
 +
===Regimen #3, Mazzucconi, et al. 2007 (every 2 week dexamethasone)===
 +
[[Levels of Evidence]]:
 +
<span
 +
style="background:#EEEE00;
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padding:3px 6px 3px 6px;
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border-color:black;
 +
border-width:2px;
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border-style:solid;">95 patients</span>
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*[[Dexamethasone (Decadron)]] 40 mg PO/IV once per day on days 1 to 4
 +
**Patients <15 years old received [[Dexamethasone (Decadron)]] 20 mg/m2 (maximum dose: 40 mg per day) PO/IV once per day on days 1 to 4
 +
*Patients who had platelet counts of ≤30 x 10<sup>9</sup>/L between cycles and/or who had bleeding related to thrombocytopenia received [[Dexamethasone (Decadron)]] 0.035 mg/kg PO once per day "between courses"
 +
 +
'''14-day cycles x 4 cycles'''
 +
 +
===References===
 +
# 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 Aug 28;349(9):831-6. [http://www.nejm.org/doi/full/10.1056/NEJMoa030254 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/12944568 PubMed] content property of [http://hemonc.org HemOnc.org]
 +
# 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 Feb 15;109(4):1401-7. Epub 2006 Oct 31. [http://bloodjournal.hematologylibrary.org/content/109/4/1401.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/17077333 PubMed]
  
 
=Relapsed/Refractory=
 
=Relapsed/Refractory=
 +
 +
==Dexamethasone, high-dose==
 +
===Regimen, Andersen, et al. 1994===
 +
Level of Evidence:
 +
<span
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style="background:#ff0000;
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padding:3px 6px 3px 6px;
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border-color:black;
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border-width:2px;
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border-style:solid;">10 patients</span>
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*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1 to 4
 +
 +
'''28-day cycles x 6 cycles'''
 +
 +
===References===
 +
# Andersen JC. Response of resistant idiopathic thrombocytopenic purpura to pulsed high-dose dexamethasone therapy. N Engl J Med. 1994 Jun 2;330(22):1560-4. [http://www.nejm.org/doi/full/10.1056/NEJM199406023302203 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/8177245 PubMed]
  
 
==Placebo==  
 
==Placebo==  
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==Romiplostim (Nplate)==  
 
==Romiplostim (Nplate)==  
  
−
===Regimen===
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===Regimen, Kuter, et al. 2008===
 
Level of Evidence:
 
Level of Evidence:
 
<span  
 
<span  
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border-style:solid;">Phase III</span>
 
border-style:solid;">Phase III</span>
  
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*[[Romiplostim (Nplate)]] varying doses SC once per week, titrated to keep platelets between 50k and 200k
+
*[[Romiplostim (Nplate)]] 1 mcg/kg (starting dose) SC once per week, with doses titrated per algorithm described in Kuter, et al. 2008
  
 
===References===
 
===References===
−
# Kuter DJ, Bussel JB, Lyons RM, Pullarkat V, Gernsheimer TB, Senecal FM, Aledort LM, George JN, Kessler CM, Sanz MA, Liebman HA, Slovick FT, de Wolf JT, Bourgeois E, Guthrie TH Jr, Newland A, Wasser JS, Hamburg SI, Grande C, Lefrère F, Lichtin AE, Tarantino MD, Terebelo HR, Viallard JF, Cuevas FJ, Go RS, Henry DH, Redner RL, Rice L, Schipperus MR, Guo DM, Nichol JL. Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: a double-blind randomised controlled trial. Lancet. 2008 Feb 2;371(9610):395-403. [http://www.sciencedirect.com/science/article/pii/S0140673608602032 link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/18242413 PubMed]
+
# Kuter DJ, Bussel JB, Lyons RM, Pullarkat V, Gernsheimer TB, Senecal FM, Aledort LM, George JN, Kessler CM, Sanz MA, Liebman HA, Slovick FT, de Wolf JT, Bourgeois E, Guthrie TH Jr, Newland A, Wasser JS, Hamburg SI, Grande C, Lefrère F, Lichtin AE, Tarantino MD, Terebelo HR, Viallard JF, Cuevas FJ, Go RS, Henry DH, Redner RL, Rice L, Schipperus MR, Guo DM, Nichol JL. Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: a double-blind randomised controlled trial. Lancet. 2008 Feb 2;371(9610):395-403. [http://www.sciencedirect.com/science/article/pii/S0140673608602032 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/18242413 PubMed]

Revision as of 00:33, 5 August 2013

Use of this site is subject to you reading and agreeing with the terms set forth in the disclaimer.

Is there a regimen missing from this list? Would you like to share a different dosage/schedule or an additional reference for a regimen? Have you noticed an error? Do you have an idea that will help the site grow to better meet your needs and the needs of many others? You are invited to contribute to the site.


Initial therapy

Dexamethasone, high-dose

Regimen #1, Cheng, et al. 2003

Levels of Evidence: 125 patients enrolled

4-day course; patients who had an initial response, but whose platelets dropped below 30,000 within 6 months received:

Regimen #2, Mazzucconi, et al. 2007 (monthly dexamethasone)

Levels of Evidence: 37 patients

28-day cycles x 6 cycles

Regimen #3, Mazzucconi, et al. 2007 (every 2 week dexamethasone)

Levels of Evidence: 95 patients

  • Dexamethasone (Decadron) 40 mg PO/IV once per day on days 1 to 4
    • Patients <15 years old received Dexamethasone (Decadron) 20 mg/m2 (maximum dose: 40 mg per day) PO/IV once per day on days 1 to 4
  • Patients who had platelet counts of ≤30 x 109/L between cycles and/or who had bleeding related to thrombocytopenia received Dexamethasone (Decadron) 0.035 mg/kg PO once per day "between courses"

14-day cycles x 4 cycles

References

  1. 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 Aug 28;349(9):831-6. link to original article contains verified protocol PubMed content property of HemOnc.org
  2. 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 Feb 15;109(4):1401-7. Epub 2006 Oct 31. link to original article contains verified protocol PubMed

Relapsed/Refractory

Dexamethasone, high-dose

Regimen, Andersen, et al. 1994

Level of Evidence: 10 patients

28-day cycles x 6 cycles

References

  1. Andersen JC. Response of resistant idiopathic thrombocytopenic purpura to pulsed high-dose dexamethasone therapy. N Engl J Med. 1994 Jun 2;330(22):1560-4. link to original article contains verified protocol PubMed

Placebo

Regimen

Level of Evidence: Phase III

No treatment; used as a comparator arm and here for reference purposes only.

References

  1. Kuter DJ, Bussel JB, Lyons RM, Pullarkat V, Gernsheimer TB, Senecal FM, Aledort LM, George JN, Kessler CM, Sanz MA, Liebman HA, Slovick FT, de Wolf JT, Bourgeois E, Guthrie TH Jr, Newland A, Wasser JS, Hamburg SI, Grande C, Lefrère F, Lichtin AE, Tarantino MD, Terebelo HR, Viallard JF, Cuevas FJ, Go RS, Henry DH, Redner RL, Rice L, Schipperus MR, Guo DM, Nichol JL. Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: a double-blind randomised controlled trial. Lancet. 2008 Feb 2;371(9610):395-403. link to original article PubMed

Romiplostim (Nplate)

Regimen, Kuter, et al. 2008

Level of Evidence: Phase III

  • Romiplostim (Nplate) 1 mcg/kg (starting dose) SC once per week, with doses titrated per algorithm described in Kuter, et al. 2008

References

  1. Kuter DJ, Bussel JB, Lyons RM, Pullarkat V, Gernsheimer TB, Senecal FM, Aledort LM, George JN, Kessler CM, Sanz MA, Liebman HA, Slovick FT, de Wolf JT, Bourgeois E, Guthrie TH Jr, Newland A, Wasser JS, Hamburg SI, Grande C, Lefrère F, Lichtin AE, Tarantino MD, Terebelo HR, Viallard JF, Cuevas FJ, Go RS, Henry DH, Redner RL, Rice L, Schipperus MR, Guo DM, Nichol JL. Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: a double-blind randomised controlled trial. Lancet. 2008 Feb 2;371(9610):395-403. link to original article contains verified protocol PubMed
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