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Idiopathic Thrombocytopenic Purpura

A Retrospective Analysis in 139 Patients of the Influence of Age on the Response to Corticosteroids, Splenectomy and Danazol

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Abstract

Objective

To review the influence of age on the response of patients with idiopathic thrombocytopenic purpura (ITP) to corticosteroids, splenectomy and danazol.

Methods

We retrospectively reviewed a cohort of 139 consecutively treated patients with ITP diagnosed between 1985 and 1994. In particular, we analysed the therapies used, their response rates, prognostic indicators of response and adverse effects. Furthermore, we compared the efficacy and tolerability of the various therapies between younger and older patients (<60 and ≥60 years old).

Results

Corticosteroids were used as first-line treatment in 118 patients with an initial response rate of 83%. Age did not affect the outcome of corticosteroid therapy, but all the patients aged ≥60 years reported adverse effects. A splenectomy was performed in 55 patients with an initial response rate of 87%. Older patients had significantly poorer outcomes from splenectomy with higher postoperative morbidity. Finally, danazol was given in 33 patients with a favourable response in 72% of cases. Compared with younger patients, older patients had a significantly better outcome with danazol.

Conclusions

Age may have significant effects on the response to and adverse effects of therapy in ITP, and this should be considered when choosing the treatment modality for the elderly.

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References

  1. Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med 2002; 346: 995–1008

    Article  PubMed  Google Scholar 

  2. Provan D, Newland A. Fifty years of idiopathic thrombocytopenic purpura (ITP): management of refractory ITP in adults. Br J Haematol 2002; 118: 933–44

    Article  PubMed  CAS  Google Scholar 

  3. Semple JW. Immune pathophysiology of autoimmune thrombocytopenic purpura. Blood Rev 2002; 16: 9–12

    Article  PubMed  CAS  Google Scholar 

  4. Nugent DJ. Childhood immune thrombocytopenic purpura. Blood Rev 2002; 16: 27–9

    Article  PubMed  CAS  Google Scholar 

  5. George JN, Woolf SH. Raskob GE, et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood 1996; 88: 3–40

    PubMed  CAS  Google Scholar 

  6. McMillan R. Classical management of refractory adult immune (idiopathic) thrombocytopenic purpura. Blood Rev 2002; 16: 51–5

    Article  PubMed  CAS  Google Scholar 

  7. Berchtold P, McMillan R. Therapy of chronic idiopathic thrombocytopenic purpura in adults. Blood 1989; 74: 2309–17

    PubMed  CAS  Google Scholar 

  8. Kurata Y, Miyagawa S, Kosugi S, et al. High-titer antinuclear antibodies, anti-SSA/Ro antibodies and anti-nuclear RNP antibodies in patients with idiopathic thrombocytopenic purpura. Thromb Haemost 1994; 71: 184–7

    PubMed  CAS  Google Scholar 

  9. Leung AY, Chim CS, Kwong YL, et al. Clinicopathologic and prognostic features of chronic idiopathic thrombocytopenic purpura in adult Chinese patients: an analysis of 220 cases. Ann Hematol 2001; 80: 384–6

    Article  PubMed  CAS  Google Scholar 

  10. Pamuk GE, Pamuk ON, Baslar Z, et al. Overview of 321 patients with idiopathic thrombocytopenic purpura: retrospective analysis of the clinical features and response to therapy. Ann Hematol 2002; 81: 436–40

    Article  PubMed  CAS  Google Scholar 

  11. Stasi R, Stipa E, Masi M, et al. Long-term observation of 208 adults with chronic idiopathic thrombocytopenic purpura. Am J Med 1995; 98: 436–42

    Article  PubMed  CAS  Google Scholar 

  12. Difino SM, Lachant NA, Kirshner JJ, et al. Adult idiopathic thrombocytopenic purpura: clinical findings and response to therapy. Am J Med 1980; 69: 430–42

    Article  PubMed  CAS  Google Scholar 

  13. Tobelem G, Chassang C, Asselain B, et al. Le purpura thrombopénique auto-immun: etude clinique et thérapeutique rétrospective de 544 observations. Nouv Presse Med 1981; 10: 2871–5

    PubMed  CAS  Google Scholar 

  14. den Ottolander GJ, Gratama JW, de Koning J, et al. Long-term follow-up study of 168 patients with immune thrombocytopenia. Scand J Haematol 1984; 32: 101–10

    Article  Google Scholar 

  15. Ahn YS, Harrington WJ, Simon SR, et al. Danazol for the treatment of idiopathic thrombocytopenic purpura. N Engl J Med 1983; 308: 1396–9

    Article  PubMed  CAS  Google Scholar 

  16. Ahn YS, Mylvaganam R, Garcia RO, et al. Low-dose danazol therapy in idiopathic thrombocytopenic purpura. Ann Intern Med 1987; 107: 177–81

    PubMed  CAS  Google Scholar 

  17. Ahn YS, Rocha R, Mylvaganam R, et al. Long-term danazol therapy in autoimmune thrombocytopenia: unmaintained remission and age-dependent response in women. Ann Intern Med 1989; 111:723–9

    PubMed  CAS  Google Scholar 

  18. Karpatkin S. Autoimmune (idiopathic) thrombocytopenic purpura. Lancet 1997; 349: 1531–6

    Article  PubMed  CAS  Google Scholar 

  19. Nalli G, Sajeva MR, Maffé GC, et al. Danazol therapy for idiopathic thrombocytopenic purpura. Haematologica 1988; 73: 55–7

    PubMed  CAS  Google Scholar 

  20. Mazzucconi MG, Francesconi M, Falcione E, et al. Danazol therapy in refractory chronic immune thrombocytopenic purpura. Acta Haematol 1987; 77: 45–7

    Article  PubMed  CAS  Google Scholar 

  21. McVerry BA, Auger M, Bellingham AJ. The use of danazol in the management of chronic immune thrombocytopenic purpura. Br J Haematol 1985; 61: 145–8

    Article  PubMed  CAS  Google Scholar 

  22. Shashaty GG, Rath CE. Idiopathic thrombocytopenic purpura in elderly. Am J Med Sci 1978; 276: 263–7

    Article  PubMed  CAS  Google Scholar 

  23. Taillan B, Hastier A, Ferrari E, et al. Purpura thrombopénique chronique chez le sujet. Nouv Presse Med 1991; 34: 1651–4

    Google Scholar 

  24. Linares M, Cervero A, Colomina P, et al. Purpura thrombopénique chronique du sujet. Nouv Presse Med 1995; 93: 80–2

    CAS  Google Scholar 

  25. Cortelazzo S, Finazzi G, Buelli M, et al. High risk of severe bleeding in aged patients with chronic idiopathic thrombocytopenic purpura. Blood 1991; 77: 31–3

    PubMed  CAS  Google Scholar 

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Acknowledgements

Conception and design: E. Andrès and F. Maloisel. Collection and assembly of data: J. Zimmer and F. Maloisel. Statistical analysis: J. Zimmer and F. Maloisel. Analysis and interpretation: E. Andrès, J. Zimmer and F. Maloisel. Drafting of the article: E. Andrès and F. Maloisel. Final approval of the manuscript: E. Andrès, J. Zimmer, E. Noel, G. Kaltenbach, A. Koumarianou and F. Maloisel. Provision of study materials or patients: E. Andrès, J. Zimmer, G. Kaltenbach, A. Koumarianou, F. Maloisel and the study group of idiopathic thrombocytopenic purpura of the Hôpitaux Universitaires de Strasbourg, France. The authors have provided no information on sources of funding or on conflicts of interest directly relevant to the content of this study.

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Authors and Affiliations

  1. Department of Internal Medicine, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

    Emmanuel Andrès & Esther Noel

  2. Department of Onco-Hematology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

    Jacques Zimmer, Argyro Koumarianou &  Frédéric Maloisel

  3. Lausanne Branch, Ludwig Institute for Cancer Research, Epalinges, Switzerland

    Jacques Zimmer

  4. Department of Internal Medicine and Geriatrics, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

    Georges Kaltenbach

Authors
  1. Emmanuel Andrès
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  2. Jacques Zimmer
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  3. Esther Noel
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  4. Georges Kaltenbach
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  5. Argyro Koumarianou
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  6. Frédéric Maloisel
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Corresponding authors

Correspondence to Emmanuel Andrès or Frédéric Maloisel.

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Andrès, E., Zimmer, J., Noel, E. et al. Idiopathic Thrombocytopenic Purpura. Drugs Aging 20, 841–846 (2003). https://doi.org/10.2165/00002512-200320110-00005

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