[Short term high-dose dexamethasone therapy in previously untreated idiopathic thrombocytopenic purpura]

To observe the long-term effect of short interim high-dose dexamethasone (HD-DXM)in previously untreated patients affected by idiopathic thrombocytopenic purpura(ITP) and investigate the action of maintenance treatment.

40 mg/d of dexamethasone was given in a 4-day pulse every 14 days for 3 cycles to 45 patients with ITP. Among them, 22 cases were given routinely dexamethasone of 0.035 mg x kg(-1) x d(-1) for maintenance treatment between courses of high-dose dexamethasone (HD-DXM + RM group)and 23 cases were given dexamethasone of 0.035 mg x kg(-1) x d(-1) only when the platelet count was lower than 20 x 10(9)/L (HD-DXM + SM group). As a control group, another 22 cases were given routine dosage of prednisone (control group).

(1) At the end of the third cycle, the effective rate in the HD-DXM + RM group was 81.8% (18/22), which was higher than 65.2% (15/23) of the HD-DXM + SM group and 63.6% (14/22) of the control group. (2) Among the HD-DXM group patients, the effective rate at the end of the third cycle was higher than that at the end of first and second cycles. (3) The effective rate of HD-DXM + RM group was higher than that of HD-DXM + SM group. (4) At the time of 1, 2, 3, and 4 months after the end of the last cycle of HD-DXM, the relapse rates in HD-DXM + RM group were 16.7%, 16.7%, 27.8% and 33.3% respectively, which were lower than that of HD-DXM + SM group and control group respectively.

A schedule of 3 cycles of HD-DXM pulses with an interval of 2 weeks between cycles is an effective method for previously untreated ITP patients and maintenance treatment with small-dose dexamethasone between high-dose dexamethasone contributes to improve the long-term curative effect.