Pediatric ; Chronic ; Thrombocytopenia ; Cyclosporine A
Abstract
Purpose: Since the treatment of chronic idiopathic thrombocytopenic purpura (ITP) remains
unsatisfactory in patients refractory to standard therapy, alternative therapies such as splenectomy,
danazol, rituximab and cyclosporine A (CsA) are being considered as recently. The efficacy and
safety of CsA has already been proved to adult patients with chronic ITP, however, there was
no previous study in pediatric patients. The purpose of this study was to evaluate the efficacy
and side effect of CsA in pediatric chronic ITP patients. Methods: We reviewed medical records
of nine steroid refractory chronic ITP patients diagnosed as chronic ITP who were treated with
CsA during 2007 and 2009 retrospectively. Results: All nine patients received standard treatment
of intravenous immunoglobulin G and steroid before receiving CsA. Average time duration to
start CsA from diagnosis was 52 months. Three children (33%) showed more than partial response
maintaining platelet count over 50×109/L, the other six patients did not show any effect. There
were no remarkable toxicities other than mild chest discomfort and headache in two patients.
Conclusion: CsA therapy is considered as a safe and effective treatment option in adult chronic
ITP patients recently, however, there is nearly no study in pediatric patients only with few case
reports. In this study only small portion of patients showed response to CsA. Since it was a
small sized study with short term follow up, long term follow up with larger patient number
is required to make conclusion