6-Mercaptopurine Fails to Improve Platelet Count in Pediatric Chronic Immune Thrombocytopenia

  • Anirban Das
  • Prateek Bhatia
  • Amita TrehanEmail author

Dear Editor,

Majority of children with chronic immune thrombocytopenia (ITP) have a benign course. Disease-modifying therapy using dexamethasone, rituximab, TPO-agonists, or splenectomy, each with long-term adverse effects and financial implications, is restricted for those with significant or troublesome bleeds [1, 2]. The index study aimed to evaluate response to 6-mercaptopurine (6MP) in children with chronic ITP, based on previous report of successful use [3]. Successive children with chronic ITP having: (a) recurrent, troublesome skin/subcutaneous/mucosal bleeds (grade 2/3), (b) no sustained response to corticosteroids, and, (c) negative HIV and ANA titers, were enrolled between July and December 2010, and prospectively started on 6MP at a dose of 50 mg/m2/day for 4-months. Pre-treatment platelet counts were compared to counts at 1, 2, 3, 4 and 6-months after staring 6MP. Complete response was defined as an increase to > 100 × 109/L, and a clinically relevant response as increase...


Author’s Contributions

AT: planned the study. AD: collected and analysed the data, and prepared the manuscript. PB: reported the hematology.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was duly obtained for this study.

Informed consent

Informed consent was duly obtained for this study.


  1. 1.
    Neunert C, Lim W, Crowther M, American Society of Hematology et al (2011) The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood 117:4190–4207CrossRefGoogle Scholar
  2. 2.
    Neunert CE, Buchanan GR, Imbach P, Intercontinental Cooperative ITP Study Group Registry II Participants et al (2013) Bleeding manifestations and management of children with persistent and chronic immune thrombocytopenia: data from the Intercontinental Cooperative ITP Study Group (ICIS). Blood 121:4457–4462CrossRefGoogle Scholar
  3. 3.
    Sobota A, Neufeld EJ, Lapsia S et al (2009) Response to mercaptopurine for refractory autoimmune cytopenias in children. Pediatr Blood Cancer 52:80–84CrossRefGoogle Scholar
  4. 4.
    Rodeghiero F, Stasi R, Gernsheimer T et al (2009) Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 113:2386–2393CrossRefGoogle Scholar
  5. 5.
    Hilgartner MW, Lanzkowsky P, Smith CH (1970) The use of azathioprine in refractory idiopathic thrombocytopenic purpura in children. Acta Paediatr Scand 59:409–415CrossRefGoogle Scholar

Copyright information

© Indian Society of Hematology and Blood Transfusion 2018

Authors and Affiliations

  1. 1.Paediatric Haematology/Oncology Unit, Department of Paediatrics, Advanced Paediatric CentrePostgraduate Institute of Medical Education and ResearchChandigarhIndia

Personalised recommendations