Idiopathic thrombocytopenic purpura in lymphoma

Five patients with idiopathic thrombocytopenic purpura (ITP) associated with malignant lymphoma are presented, and twelve other cases reported in the literature are reviewed. Thirteen patients (76%) had Hodgkin's disease; two had diffuse histiocytic, one, diffuse mixed lymphoma. Idiopathic thrombocytopenic purpura presented as the sole clinical manifestation of initial or recurrent lymphoma in 10 of 15 cases (67%). The spleen was not palpable even in patients who showed involvement with lymphoma at splenectomy. Three patients were asplenic at the onset of idiopathic thrombocytopenic purpura. Successful therapy of the thrombocytopenia correlated with effective control of the underlying lymphoma. Splenectomy gave favorable results in 9 of 10 cases (90%) and uncovered occult lymphoma in five patients. Chemotherapeutic drugs were successful in seven of 12 trials (58%) and only when the underlying disease was also controlled. The overall prognosis was related to the status of the lymphoma and was not altered by the occurrence of the idiopathic thrombocytopenic purpura.