Corticosteroid responsive immune thrombocytopenia in Hodgkin's disease

A 72-year-old female is described in whom immune thrombocytopenia (ITP) and fever were the presenting features of stage IIB Hodgkin's disease (HD) of the nodular sclerosis type. Thrombocytopenia resolved following steroid therapy, and after having received MOPP chemotherapy the patient is in sustained remission and with normal platelet counts 18 months later. Review of the 35 cases published to date with ITP in HD shows that of 20 patients treated with corticosteroids alone, 14 failed to respond, 2 had a partial response and only 4 patients had a good response. In contrast, of 29 splenectomised patients only 7 failed to respond, 2 had a partial response, and 20 had a good response. The state of activity of HD was closely correlated with the response of thrombocytopenia to treatment by either corticosteroids or splenectomy: only 7 of 17 patients with active HD achieved a resolution of thrombocytopenia as compared to 15 of 17 patients with HD in remission. Thus, control of thrombocytopenia is easier in patients in remission than in patients with active HD, and splenectomy is more efficient in controlling thrombocytopenia than corticosteroids.