Table 6.
Combination treatment at diagnosis of ITP
| References | Arms, n | Medications | Dosing | Cycles, n | Patients, n | Follow-up | Serious treatment complications | Notes | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Reported response | 1 mo | 6 mo | 12 mo | 24 mo | Kidney | Liver Gr3 | Thrombosis, % | Infections | Other | |||||||
| Zaja et al57 | 1 | Dexamethasone | 40 mg PO, daily, days 1-4 | 1 | 52 | SR 63% in the combination arm vs 36% in the dexamethasone arm | 46% | 36% | 0% | 0% | 0 | 0% | SR, plt > 50 000/µL at 6 mo. Hematologic response, plt > 100 000/µL. Patients on dexamethasone monotherapy with NR received rituximab, with 56% SR. | |||
| 2 | Dexamethasone | 40 mg PO, daily, days 1-4 | 49 | 37% | 63% | 0% | 4% | 0 | 4% | 2% bleeding | ||||||
| Rituximab | 375 mg/m2 IV, days 7, 14, 21, and 28 | 4% SVT, 2% seizure | ||||||||||||||
| Gómez-Almaguer et al122 | 1 | Dexamethasone | 40 mg PO, daily, days 1-4 | 1 | 12 | CR, 83%; response, 17%; 33% relapsed; RFS, 67% at 1 y; CR2, 50%; response 2, 25% | Response, 17%; CR, 83% | RFS, 67% | No | 0% | 0% | 0 | 0% | Response, plt: 30 000-100 000/µL; CR, plt >100 000/µL at day 33. Response 2 and CR2 same as response and CR but at 6 mo | ||
| Eltrombopag | 50 mg PO, daily for 28 d | |||||||||||||||
| 75% grade 2 bleeding. | ||||||||||||||||
| Wang et al123 | 1 | Dexamethasone | 40 mg PO, daily, days 1-4 ± days 11-14 | 100 | At 14 d: CR + response 89% in the combination arms vs 67% in the dexamethasone arm; CR, 75% vs 43%. At 6 mo: CR + response 65% in the combination arm vs 37% in the dexamethasone arm; CR, 46% vs 32%. | CR, 46%; response, 19% | 1 | 2% ICH but not deemed to be treatment related. If plt < 10 000/µL, rescue medications, plt transfusions, and hemostatic agents were allowed. Response, plt between 30 000-100 000/µL and twofold increase of baseline plt and no bleeding; CR, plt 100 000/µL. | ||||||||
| rhTPO | 300 U/kg SQ, daily for 14 d | |||||||||||||||
| 2 | Dexamethasone | 40 mg PO, daily, days 1-4 ± days 11-14 | 96 | CR, 32%; response, 5% | ||||||||||||
| Zhang et al124 | 1 | Eltrombopag | 25-75 mg/d for 12 wk | 46 | 56% of the patients with prolonged response | ASH abstract | ||||||||||
| Dexamethasone | 40 mg PO, daily, days 1-4 | 1-3 | No major adverse effects | |||||||||||||
ASH, American Society of Hematology; Gr3, grade 3; ICH, intracranial hemorrhage; NR, no response; plt, platelets; PO, by mouth; rhTPO, recombinant human TPO; RFS, relapse-free survival; SQ, subcutaneously; SR, sustained response, SVT, supraventricular tachycardia.