4R+3Dex Regimen May Lead to Durable Complete Response in Pediatric Chronic ITP

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Additional treatment methods are needed for those with persistent ITP.
Additional treatment methods are needed for those with persistent ITP.

Female adolescent patients with a diagnosis of chronic idiopathic thrombocytopenic purpura (ITP) made less than 2 years prior may experience durable, unmaintained remission once treated with 4 infusions of rituximab and 3 4-day cycles of dexamethasone (4R+3Dex), according to a study published in The Journal of Pediatrics

Immunomodulation is the most commonly utilized therapeutic approach for patients with ITP initially, but there is a need for additional treatment methods for persistent disease. Previous studies have demonstrated that rituximab plus dexamethasone may lead to superior immediate and long-term outcomes.

For this study, researchers treated 33 pediatric patients with persistent/chronic ITP with 4R+3Dex. Eligible study patients had failed at least 1 previous therapy.

The average age of nonresponders to treatment was 7.75 years, and the average of patients who displayed an initial treatment response was 12.69 years (P =.0073) regardless of gender.

Of the 15 patients who initially responded to treatment, 40% relapsed within the 5-year follow-up after completion of 4R+3Dex. Of the initial responders, 2 patients achieved a partial response and 13 patients achieved a complete response (CR). Patients had similar initial response rates regardless of gender, but of the 10 patients who maintained CR only 2 were male patients and 8 were female patients with ITP less than 24 months prior to treatment.

The authors concluded, “[t]his provides a new therapeutic paradigm for a subpopulation with hard-to-treat chronic ITP. The pathophysiology of ITP underlying this distinction requires further elucidation.”


Oved JH, Lee CSY, Bussel HB. Treatment of children with persistent and chronic idiopathic thrombocytopenic purpura: 4 infusions of rituximab and three 4-day cycles of dexamethasone. J Pediatrics. 2017;191:225-231. doi: 10.1016/j.jpeds.2017.08.036

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