Seminars in Hematology
Volume 44 , Pages S12-S23 , October 2007

Current Options for the Treatment of Idiopathic Thrombocytopenic Purpura

  • Donald M. Arnold
    • ,
  • John G. Kelton

      Affiliations

    • Corresponding Author InformationAddress correspondence to John G. Kelton, MD, McMaster University, 1200 Main St W, Room 2E1, Hamilton, Ontario, Canada L8N 3Z5.

References 

  1. McMillan R. Therapy for adults with refractory chronic immune thrombocytopenic purpura. Ann Intern Med. 1997;126:307–314
  2. Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med. 2002;346:995–1008
  3. Psaila B, Bussel JB. Immune thrombocytopenic purpura. Hematol Oncol Clin North Am. 2007;21:743–759
  4. Burrows RF, Kelton JG. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. N Engl J Med. 1993;329:1463–1466
  5. Frederiksen H, Schmidt K. The incidence of idiopathic thrombocytopenic purpura in adults increases with age. Blood. 1999;94:909–913
  6. Cohen YC, Djulbegovic B, Shamai-Lubovitz O, Mozes B. The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts. Arch Intern Med. 2000;160:1630–1638
  7. Rossi D, De Paoli L, Franceschetti S, Capello D, Vendramin C, Lunghi M, et al. Prevalence and clinical characteristics of immune thrombocytopenic purpura in a cohort of monoclonal gammopathy of uncertain significance. Br J Haematol. 2007;138:249–252
  8. Stasi R, Amadori S, Osborn J, Newland AC, Provan D. Long-term outcome of otherwise healthy individuals with incidentally discovered borderline thrombocytopenia. PLoS Med. 2006;3:e24
  9. Vantelon JM, Godeau B, Andre C, Bierling P. Screening for autoimmune markers is unnecessary during follow-up of adults with autoimmune thrombocytopenic purpura and no autoimmune markers at onset. Thromb Haemost. 2000;83:42–45
  10. Warner MN, Moore JC, Warkentin TE, Santos AV, Kelton JG. A prospective study of protein-specific assays used to investigate idiopathic thrombocytopenic purpura. Br J Haematol. 1999;104:442–447
  11. McMillan R. Antiplatelet antibodies in chronic adult immune thrombocytopenic purpura: Assays and epitopes. J Pediatr Hematol Oncol. 2003;25(suppl 1):S57–S61
  12. Kurata Y, Hayashi S, Kiyoi T, Kosugi S, Kashiwagi H, Honda S, et al. Diagnostic value of tests for reticulated platelets, plasma glycocalicin, and thrombopoietin levels for discriminating between hyperdestructive and hypoplastic thrombocytopenia. Am J Clin Pathol. 2001;115:656–664
  13. Kuwana M, Kurata Y, Fujimura K, Fujisawa K, Wada H, Nagasawa T, et al. Preliminary laboratory based diagnostic criteria for immune thrombocytopenic purpura: Evaluation by multi-center prospective study. J Thromb Haemost. 2006;4:1936–1943
  14. Page LK, Psaila B, Provan D, Michael Hamilton J, Jenkins JM, Elish AS, et al. The immune thrombocytopenic purpura (ITP) bleeding score: Assessment of bleeding in patients with ITP. Br J Haematol. 2007;138:245–248
  15. McMillan R, Bussel JB, George JN, Lalla D, Nichol JL: Self-reported health-related quality of life in adults with chronic immune thrombocytopenic purpura. Am J Hematol (in press)
  16. Ruggeri M, Fortuna S, Rodeghiero F. Heterogeneity of terminology and clinical definitions in adult idiopathic thrombocytopenic purpura: A critical appraisal from literature analysis. Pediatr Blood Cancer. 2006;47:653–656
  17. Dan K, Gomi S, Kuramoto A, Maekawa T, Nomura T. A multicenter prospective study on the treatment of chronic idiopathic thrombocytopenic purpura. Int J Hematol. 1992;55:287–292
  18. Portielje JE, Westendorp RG, Kluin-Nelemans HC, Brand A. Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood. 2001;97:2549–2554
  19. Berchtold P, McMillan R. Therapy of chronic idiopathic thrombocytopenic purpura in adults. Blood. 1989;74:2309–2317
  20. George JN, Woolf SH, Raskob GE, Wasser JS, Aledort LM, Ballem PJ, et al. Idiopathic thrombocytopenic purpura: A practice guideline developed by explicit methods for the American Society of Hematology. Blood. 1996;88:3–40
  21. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol. 2003;120:574–596
  22. McMillan R, Durette C. Long-term outcomes in adults with chronic ITP after splenectomy failure. Blood. 2004;104:956–960
  23. Buchanan GR. The nontreatment of childhood idiopathic thrombocytopenic purpura. Eur J Pediatr. 1987;146:107–112
  24. Ben-Yehuda D, Gillis S, Eldor A. Clinical and therapeutic experience in 712 Israeli patients with idiopathic thrombocytopenic purpura (Israeli ITP Study Group). Acta Haematol. 1994;91:1–6
  25. Stasi R, Stipa E, Masi M, Cecconi M, Scimo MT, Oliva F, et al. Long-term observation of 208 adults with chronic idiopathic thrombocytopenic purpura. Am J Med. 1995;98:436–442
  26. Andres E, Zimmer J, Noel E, Kaltenbach G, Koumarianou A, Maloisel F. Idiopathic thrombocytopenic purpura: A retrospective analysis in 139 patients of the influence of age on the response to corticosteroids, splenectomy and danazol. Drugs Aging. 2003;20:841–846
  27. Pizzuto J, Ambriz R. Therapeutic experience on 934 adults with idiopathic thrombocytopenic purpura: Multicentric Trial of the Cooperative Latin American group on Hemostasis and Thrombosis. Blood. 1984;64:1179–1183
  28. Stasi R, Venditti A, Del Poeta G, Conforti M, Brunetti M, Bussa S, et al. Role of human leukocyte interferon-alpha in the treatment of patients with polycythemia vera. Am J Med Sci. 1998;315:237–241
  29. Leung AY, Chim CS, Kwong YL, Lie AK, Au WY, Liang R. Clinicopathologic and prognostic features of chronic idiopathic thrombocytopenic purpura in adult Chinese patients: an analysis of 220 cases. Ann Hematol. 2001;80:384–386
  30. Pamuk GE, Pamuk ON, Baslar Z, Ongoren S, Soysal T, Ferhanoglu B, et al. Overview of 321 patients with idiopathic thrombocytopenic purpura (Retrospective analysis of the clinical features and response to therapy). Ann Hematol. 2002;81:436–440
  31. DiFino SM, Lachant NA, Kirshner JJ, Gottlieb AJ. Adult idiopathic thrombocytopenic purpura (Clinical findings and response to therapy). Am J Med. 1980;69:430–442
  32. Bellucci S, Charpak Y, Chastang C, Tobelem G. Low doses v conventional doses of corticoids in immune thrombocytopenic purpura (ITP): Results of a randomized clinical trial in 160 children, 223 adults. Blood. 1988;71:1165–1169
  33. Mazzucconi MG, Francesconi M, Fidani P, Di Nucci G, Gandolfo GM, Afeltra A, et al. Treatment of idiopathic thrombocytopenic purpura (ITP): Results of a multicentric protocol. Haematologica. 1985;70:329–336
  34. Alpdogan O, Budak-Alpdogan T, Ratip S, Firatli-Tuglular T, Tanriverdi S, Karti S, et al. Efficacy of high-dose methylprednisolone as a first-line therapy in adult patients with idiopathic thrombocytopenic purpura. Br J Haematol. 1998;103:1061–1063
  35. Kuku I, Aydogdu I, Kaya E, Ali Erkurt M, Dikilitas M, Baydar M, et al. The early and long-term results of oral high-dose methylprednisolone treatment in adult patients with idiopathic thrombocytopenic purpura. Eur J Haematol. 2005;74:271–272
  36. Albayrak D, Islek I, Kalayci AG, Gurses N. Acute immune thrombocytopenic purpura: A comparative study of very high oral doses of methylprednisolone and intravenously administered immune globulin. J Pediatr. 1994;125:1004–1007
  37. Cheng Y, Wong RS, Soo YO, Chui CH, Lau FY, Chan NP, et al. Initial treatment of immune thrombocytopenic purpura with high-dose dexamethasone. N Engl J Med. 2003;349:831–836
  38. Mazzucconi MG, Fazi P, Bernasconi S, De Rossi G, Leone G, Gugliotta L, et al. Therapy with high-dose dexamethasone (HD-DXM) in previously untreated patients affected by idiopathic thrombocytopenic purpura: A GIMEMA experience. Blood. 2007;109:1401–1407
  39. Andersen JC. Response of resistant idiopathic thrombocytopenic purpura to pulsed high-dose dexamethasone therapy. N Engl J Med. 1994;330:1560–1564
  40. Stasi R, Brunetti M, Pagano A, Stipa E, Masi M, Amadori S. Pulsed intravenous high-dose dexamethasone in adults with chronic idiopathic thrombocytopenic purpura. Blood Cells Mol Dis. 2000;26:582–586
  41. Warner M, Wasi P, Couban S, Hayward C, Warkentin T, Kelton JG. Failure of pulse high-dose dexamethasone in chronic idiopathic immune thrombocytopenia. Am J Hematol. 1997;54:267–270
  42. Borgna-Pignatti C, Rugolotto S, Nobili B, Amendola G, De Stefano P, Maccario R, et al. A trial of high-dose dexamethasone therapy for chronic idiopathic thrombocytopenic purpura in childhood. J Pediatr. 1997;130:13–16
  43. Chen JS, Wu JM, Chen YJ, Yeh TF. Pulsed high-dose dexamethasone therapy in children with chronic idiopathic thrombocytopenic purpura. J Pediatr Hematol Oncol. 1997;19:526–529
  44. Imbach P, Barandun S, d’Apuzzo V, Baumgartner C, Hirt A, Morell A, et al. High-dose intravenous gammaglobulin for idiopathic thrombocytopenic purpura in childhood. Lancet. 1981;1:1228–1231
  45. Fehr J, Hofmann V, Kappeler U. Transient reversal of thrombocytopenia in idiopathic thrombocytopenic purpura by high-dose intravenous gamma globulin. N Engl J Med. 1982;306:1254–1258
  46. Salama A, Mueller-Eckhardt C, Kiefel V. Effect of intravenous immunoglobulin in immune thrombocytopenia. Lancet. 1983;2:193–195
  47. Kelton JG, Singer J, Rodger C, Gauldie J, Horsewood P, Dent P. The concentration of IgG in the serum is a major determinant of Fc-dependent reticuloendothelial function. Blood. 1985;66:490–495
  48. Cooper N, Stasi R, Cunningham-Rundles S, Feuerstein MA, Leonard JP, Amadori S, et al. The efficacy and safety of B-cell depletion with anti-CD20 monoclonal antibody in adults with chronic immune thrombocytopenic purpura. Br J Haematol. 2004;125:232–239
  49. Lemieux R, Bazin R, Neron S. Therapeutic intravenous immunoglobulins. Mol Immunol. 2005;42:839–848
  50. Crow AR, Song S, Freedman J, Helgason CD, Humphries RK, Siminovitch KA, et al. IVIg-mediated amelioration of murine ITP via FcgammaRIIB is independent of SHIP1, SHP-1, and Btk activity. Blood. 2003;102:558–560
  51. Siragam V, Crow AR, Brinc D, Song S, Freedman J, Lazarus AH. Intravenous immunoglobulin ameliorates ITP via activating Fc gamma receptors on dendritic cells. Nat Med. 2006;12:688–692
  52. Beck CE, Nathan PC, Parkin PC, Blanchette VS, Macarthur C. Corticosteroids versus intravenous immune globulin for the treatment of acute immune thrombocytopenic purpura in children: A systematic review and meta-analysis of randomized controlled trials. J Pediatr. 2005;147:521–527
  53. Godeau B, Chevret S, Varet B, Lefrere F, Zini JM, Bassompierre F, et al. Intravenous immunoglobulin or high-dose methylprednisolone, with or without oral prednisone, for adults with untreated severe autoimmune thrombocytopenic purpura: A randomised, multicentre trial. Lancet. 2002;359:23–29
  54. Blanchette V, Imbach P, Andrew M, Adams M, McMillan J, Wang E, et al. Randomised trial of intravenous immunoglobulin G, intravenous anti-D, and oral prednisone in childhood acute immune thrombocytopenic purpura. Lancet. 1994;344:703–707
  55. Tarantino MD, Young G, Bertolone SJ, Kalinyak KA, Shafer FE, Kulkarni R, et al. Single dose of anti-D immune globulin at 75 microg/kg is as effective as intravenous immune globulin at rapidly raising the platelet count in newly diagnosed immune thrombocytopenic purpura in children. J Pediatr. 2006;148:489–494
  56. Bussel JB, Eldor A, Kelton JG, Varon D, Brenner B, Gillis S, et al. IGIV-C, a novel intravenous immunoglobulin: evaluation of safety, efficacy, mechanisms of action, and impact on quality of life. Thromb Haemost. 2004;91:771–778
  57. Heddle NM, Kelton JG, Turchyn KL, Ali MA. Hypergammaglobulinemia can be associated with a positive direct antiglobulin test, a nonreactive eluate, and no evidence of hemolysis. Transfusion. 1988;28:29–33
  58. Kjaersgaard M, Hasle H. A review of anti-D treatment of childhood idiopathic thrombocytopenic purpura. Pediatr Blood Cancer. 2006;47:717–720
  59. Ramadan KM, El-Agnaf M. Efficacy and response to intravenous anti-D immunoglobulin in chronic idiopathic thrombocytopenic purpura. Clin Lab Haematol. 2005;27:267–269
  60. Scaradavou A, Woo B, Woloski BM, Cunningham-Rundles S, Ettinger LJ, Aledort LM, et al. Intravenous anti-D treatment of immune thrombocytopenic purpura: Experience in 272 patients. Blood. 1997;89:2689–2700
  61. Bussel J. Treatment of immune thrombocytopenic purpura in adults. Semin Hematol. 2006;43(suppl):S3–S10
  62. Gaines AR. Disseminated intravascular coagulation associated with acute hemoglobinemia or hemoglobinuria following Rh(0)(D) immune globulin intravenous administration for immune thrombocytopenic purpura. Blood. 2005;106:1532–1537
  63. Newman GC, Novoa MV, Fodero EM, Lesser ML, Woloski BM, Bussel JB. A dose of 75 microg/kg/d of i.v. anti-D increases the platelet count more rapidly and for a longer period of time than 50 microg/kg/d in adults with immune thrombocytopenic purpura. Br J Haematol. 2001;112:1076–1078
  64. Godeau B, Caulier MT, Decuypere L, Rose C, Schaeffer A, Bierling P. Intravenous immunoglobulin for adults with autoimmune thrombocytopenic purpura: Results of a randomized trial comparing 0.5 and 1 g/kg b.w. Br J Haematol. 1999;107:716–719
  65. Godeau B, Lesage S, Divine M, Wirquin V, Farcet JP, Bierling P. Treatment of adult chronic autoimmune thrombocytopenic purpura with repeated high-dose intravenous immunoglobulin. Blood. 1993;82:1415–1421
  66. Bierling P, Godeau B. Intravenous immunoglobulin for autoimmune thrombocytopenic purpura. Hum Immunol. 2005;66:387–394
  67. Bussel JB, Kimberly RP, Inman RD, Schulman I, Cunningham-Rundles C, Cheung N, et al. Intravenous gammaglobulin treatment of chronic idiopathic thrombocytopenic purpura. Blood. 1983;62:480–486
  68. Bussel JB, Pham LC, Aledort L, Nachman R. Maintenance treatment of adults with chronic refractory immune thrombocytopenic purpura using repeated intravenous infusions of gammaglobulin. Blood. 1988;72:121–127
  69. George JN, Raskob GE, Vesely SK, Moore D, Lyons RM, Cobos E, et al. Initial management of immune thrombocytopenic purpura in adults: A randomized controlled trial comparing intermittent anti-D with routine care. Am J Hematol. 2003;74:161–169
  70. Kojouri K, Vesely SK, Terrell DR, George JN. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: A systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood. 2004;104:2623–2634
  71. Law C, Marcaccio M, Tam P, Heddle N, Kelton JG. High-dose intravenous immune globulin and the response to splenectomy in patients with idiopathic thrombocytopenic purpura. N Engl J Med. 1997;336:1494–1498
  72. Choi CW, Kim BS, Seo JH, Shin SW, Kim YH, Kim JS, et al. Response to high-dose intravenous immune globulin as a valuable factor predicting the effect of splenectomy in chronic idiopathic thrombocytopenic purpura patients. Am J Hematol. 2001;66:197–202
  73. Holt D, Brown J, Terrill K, Goldsby R, Meyers RL, Heximer J, et al. Response to intravenous immunoglobulin predicts splenectomy response in children with immune thrombocytopenic purpura. Pediatrics. 2003;111:87–90
  74. Hemmila MR, Foley DS, Castle VP, Hirschl RB. The response to splenectomy in pediatric patients with idiopathic thrombocytopenic purpura who fail high-dose intravenous immune globulin. J Pediatr Surg. 2000;35:967–971
  75. Phom H, Kumar A, Tripathi M, Chandrashekar N, Choudhry VP, Malhotra A, et al. Comparative evaluation of Tc-99m-heat-denatured RBC and Tc-99m-anti-D IgG opsonized RBC spleen planar and SPECT scintigraphy in the detection of accessory spleen in postsplenectomy patients with chronic idiopathic thrombocytopenic purpura. Clin Nucl Med. 2004;29:403–409
  76. Velanovich V, Shurafa M. Laparoscopic excision of accessory spleen. Am J Surg. 2000;180:62–64
  77. Marcaccio MJ. Laparoscopic splenectomy in chronic idiopathic thrombocytopenic purpura. Semin Hematol. 2000;37:267–274
  78. Sampath S, Meneghetti AT, MacFarlane JK, Nguyen NH, Benny WB, Panton ON. An 18-year review of open and laparoscopic splenectomy for idiopathic thrombocytopenic purpura. Am J Surg. 2007;193:580–583
  79. Bisharat N, Omari H, Lavi I, Raz R. Risk of infection and death among post-splenectomy patients. J Infect. 2001;43:182–186
  80. Recommendations of the Advisory Committee on Immunization Practices (ACIP): Use of vaccines and immune globulins for persons with altered immunocompetence. MMWR Recomm Rep. 1993;42:1–18
  81. Cines DB, Bussel JB. How I treat idiopathic thrombocytopenic purpura (ITP). Blood. 2005;106:2244–2251
  82. Di Gaetano N, Cittera E, Nota R, Vecchi A, Grieco V, Scanziani E, et al. Complement activation determines the therapeutic activity of rituximab in vivo. J Immunol. 2003;171:1581–1587
  83. Golay J, Zaffaroni L, Vaccari T, Lazzari M, Borleri GM, Bernasconi S, et al. Biologic response of B lymphoma cells to anti-CD20 monoclonal antibody rituximab in vitro: CD55 and CD59 regulate complement-mediated cell lysis. Blood. 2000;95:3900–3908
  84. Golay J, Lazzari M, Facchinetti V, Bernasconi S, Borleri G, Barbui T, et al. CD20 levels determine the in vitro susceptibility to rituximab and complement of B-cell chronic lymphocytic leukemia: Further regulation by CD55 and CD59. Blood. 2001;98:3383–3389
  85. Stasi R, Pagano A, Stipa E, Amadori S. Rituximab chimeric anti-CD20 monoclonal antibody treatment for adults with chronic idiopathic thrombocytopenic purpura. Blood. 2001;98:952–957
  86. Arnold DM, Dentali F, Crowther MA, Meyer RM, Cook RJ, Sigouin C, et al. Systematic review: Efficacy and safety of rituximab for adults with idiopathic thrombocytopenic purpura. Ann Intern Med. 2007;146:25–33
  87. Godeau B, Fain O, Porcher R, Lefrere F, Fenaux P, Cheze S, et al. Rituximab is an alternative to splenectomy in adults with chronic immune thrombocytopenic purpura: Results of a multicenter prospective phase 2 study. ASH Annual Meeting Abstracts. 2006;108:478
  88. Patel V, Mihatov N, Cooper N, Stasi R, Cunningham-Rundles S, Bussel JB. Long term follow-up of patients with immune thrombocytopenic purpura (ITP) whose initial response to rituximab lasted a minimum of 1 year. ASH Annual Meeting Abstracts. 2006;108:479
  89. Stasi R, Del Poeta G, Stipa E, Evangelista ML, Trawinska MM, Cooper N, et al. Response to B-cell depleting therapy with rituximab reverts the abnormalities of T cell subsets in patients with idiopathic thrombocytopenic purpura. Blood. 2007;110:2924–2930
  90. Bennett CM, Rogers ZR, Kinnamon DD, Bussel JB, Mahoney DH, Abshire TC, et al. Prospective phase 1/2 study of rituximab in childhood and adolescent chronic immune thrombocytopenic purpura. Blood. 2006;107:2639–2642
  91. US Food and Drug Administration. FDA Warns of Safety Concern Regarding Rituxan in New Patient Population. Washington, DC: FDA; 2006;
  92. Boruchov DM, Gururangan S, Driscoll MC, Bussel JB. Multi-agent induction and maintenance therapy for patients with refractory immune thrombocytopenic purpura (ITP). Blood. 2007;110:3526–3531
  93. Vesely SK, Perdue JJ, Rizvi MA, Terrell DR, George JN. Management of adult patients with persistent idiopathic thrombocytopenic purpura following splenectomy: A systematic review. Ann Intern Med. 2004;140:112–120
  94. Damodar S, Viswabandya A, George B, Mathews V, Chandy M, Srivastava A. Dapsone for chronic idiopathic thrombocytopenic purpura in children and adults—A report on 90 patients. Eur J Haematol. 2005;75:328–331
  95. Clunie GP, Lennard L. Relevance of thiopurine methyltransferase status in rheumatology patients receiving azathioprine. Rheumatology (Oxford). 2004;43:13–18
  96. Allison AC, Eugui EM. Mycophenolate mofetil and its mechanisms of action. Immunopharmacology. 2000;47:85–118
  97. Provan D, Moss AJ, Newland AC, Bussel JB. Efficacy of mycophenolate mofetil as single-agent therapy for refractory immune thrombocytopenic purpura. Am J Hematol. 2005;81:19–25
  98. Kappers-Klunne MC, van’t Veer MB. Cyclosporin A for the treatment of patients with chronic idiopathic thrombocytopenic purpura refractory to corticosteroids or splenectomy. Br J Haematol. 2001;114:121–125
  99. Emilia G, Morselli M, Luppi M, Longo G, Marasca R, Gandini G, et al. Long-term salvage therapy with cyclosporin A in refractory idiopathic thrombocytopenic purpura. Blood. 2002;99:1482–1485
  100. Zver S, Zupan IP, Cernelc P. Cyclosporin A as an immunosuppressive treatment modality for patients with refractory autoimmune thrombocytopenic purpura after splenectomy failure. Int J Hematol. 2006;83:238–242
  101. Huhn RD, Fogarty PF, Nakamura R, Read EJ, Leitman SF, Rick ME, et al. High-dose cyclophosphamide with autologous lymphocyte-depleted peripheral blood stem cell (PBSC) support for treatment of refractory chronic autoimmune thrombocytopenia. Blood. 2003;101:71–77
  102. Sikorska A, Slomkowski M, Marlanka K, Konopka L, Gorski T. The use of vinca alkaloids in adult patients with refractory chronic idiopathic thrombocytopenia. Clin Lab Haematol. 2004;26:407–411
  103. Facon T, Caulier MT, Wattel E, Jouet JP, Bauters F, Fenaux P. A randomized trial comparing vinblastine in slow infusion and by bolus i.v. injection in idiopathic thrombocytopenic purpura: A report on 42 patients. Br J Haematol. 1994;86:678–680
  104. Williams JA, Boxer LA. Combination therapy for refractory idiopathic thrombocytopenic purpura in adolescents. J Pediatr Hematol Oncol. 2003;25:232–235
  105. Kosugi S, Kurata Y, Tomiyama Y, Tahara T, Kato T, Tadokoro S, et al. Circulating thrombopoietin level in chronic immune thrombocytopenic purpura. Br J Haematol. 1996;93:704–706
  106. McMillan R, Wang L, Tomer A, Nichol J, Pistillo J. Suppression of in vitro megakaryocyte production by antiplatelet autoantibodies from adult patients with chronic ITP. Blood. 2004;103:1364–1369
  107. Bussel JB, Kuter DJ, George JN, McMillan R, Aledort LM, Conklin GT, et al. AMG 531, a thrombopoiesis-stimulating protein, for chronic ITP. N Engl J Med. 2006;355:1672–1681
  108. Kuwana M, Nomura S, Fujimura K, Nagasawa T, Muto Y, Kurata Y, et al. Effect of a single injection of humanized anti-CD154 monoclonal antibody on the platelet-specific autoimmune response in patients with immune thrombocytopenic purpura. Blood. 2004;103:1229–1236
  109. McMinn JR, Cohen S, Moore J, Lilly S, Parkhurst J, Tarantino MD, et al. Complete recovery from refractory immune thrombocytopenic purpura in three patients treated with etanercept. Am J Hematol. 2003;73:135–140
  110. Baumann MA, Menitove JE, Aster RH, Anderson T. Urgent treatment of idiopathic thrombocytopenic purpura with single-dose gammaglobulin infusion followed by platelet transfusion. Ann Intern Med. 1986;104:808–809
  111. Chandramouli NB, Rodgers GM. Prolonged immunoglobulin and platelet infusion for treatment of immune thrombocytopenia. Am J Hematol. 2000;65:85–86

 Financial support for the development of this article was provided by an independent grant from GlaxoSmithKline. Funding: D.M.A. is a New Investigator for the Canadian Institutes for Health Research. J.G.K. is a Canada Research Chair.STATEMENT OF CONFLICT OF INTEREST: Dr Kelton has received consulting fees from GlaxoSmithKline. Dr Arnold has received grant/research support from the Canadian Blood Services, and has received grant monies from Hoffman-LaRoche; he will discuss the unlabeled/unapproved use of rituximab for idiopathic thrombocytopenic purpura.

PII: S0037-1963(07)00160-6

doi: 10.1053/j.seminhematol.2007.11.003

Seminars in Hematology
Volume 44 , Pages S12-S23 , October 2007

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