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Dapsone: An Old but Effective Therapy in Pediatric Refractory Immune Thrombocytopenia

Sanjeev Khera1, Suman Kumar Pramanik2, Uday Yanamandra2

  • 1Department of Pediatrics, Army Hospital Research and Referral, Delhi, 110010 India.

Indian Journal of Hematology & Blood Transfusion : an Official Journal of Indian Society of Hematology and Blood Transfusion
|October 26, 2020
PubMed

Insights

Dapsone effectively treats chronic immune thrombocytopenia (ITP) in children refractory to other therapies. This economical drug shows a 72% response rate with a good safety profile, offering a viable option for pediatric ITP management.

Area of Science:

  • Pediatric Hematology
  • Immunology
  • Pharmacology

Background:

  • Management of chronic or refractory immune thrombocytopenia (ITP) in children lacks definitive guidelines.
  • Dapsone is an underutilized, cost-effective, and potentially efficacious treatment for chronic ITP.

Purpose of the Study:

  • To evaluate the efficacy and safety of dapsone in managing chronic ITP in pediatric patients.
  • To assess dapsone's response rates, time to response, and side effects in children with refractory ITP.

Main Methods:

  • Retrospective analysis of children under 14 years with chronic ITP and significant bleeding, refractory to splenectomy, rituximab, or eltrombopag.
  • Dapsone therapy was initiated at 1-2 mg/kg/day, excluding patients with dapsone intolerance or G6PD deficiency.
  • Outcomes were assessed based on international working group definitions for response, time to response, and adverse events.

Main Results:

  • Overall response to dapsone was observed in 72% of 29 analyzed children (7% complete response, 48% partial response).
  • Responses were sustained for at least 3 months, with a median time to response of 2.9 months.
  • Major side effects included methemoglobinemia (1 case) and skin ulceration (2 cases); 21% relapse rate was noted.

Conclusions:

  • Dapsone is an economical and effective therapeutic option for children with chronic or refractory immune thrombocytopenia.
  • The drug demonstrates a favorable safety profile, making it a valuable treatment choice in pediatric ITP management.
  • Dapsone offers a viable alternative for patients unresponsive to established therapies like splenectomy, rituximab, or eltrombopag.

Keywords:
Chronic ITPDapsoneImmune thrombocytopeniaRefractory ITP

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