International Journal of Hematology

, Volume 99, Issue 5, pp 597–602 | Cite as

Identification of predictive factors for response to intravenous immunoglobulin treatment in children with immune thrombocytopenia

  • Yoshihito Morimoto
  • Nao Yoshida
  • Nozomu Kawashima
  • Kimikazu Matsumoto
  • Koji Kato
Original Article

Abstract

Acute immune thrombocytopenia (ITP) is a common benign bleeding disorder of variable etiology characterized by isolated thrombocytopenia. Intravenous immunoglobulin (IVIG) treatment is generally given as an initial treatment to pediatric patients with ITP, but markers predictive of the response to IVIG remain poorly defined. We retrospectively evaluated whether clinical and laboratory findings before treatment could predict response to IVIG and progression to chronic ITP in Japanese children with ITP. Between April 1997 and December 2011, a total of 49 children with newly diagnosed ITP were initially treated with IVIG. Their medical records were retrospectively reviewed. In multivariate analyses, lower white blood cell (WBC) count was the only unfavorable factor for response to IVIG and progression to chronic ITP. Patients with WBC count <7.0 × 109/L had a lower probability of thrombocytopenia-free survival (41 vs. 77 %, P = 0.003) and a higher rate of progression to chronic ITP (29 vs. 6 %, P = 0.040) than those with WBC count ≥7.0 × 109/L. These results suggest that ITP with lower WBC count may represent a distinct subgroup requiring initial treatment other than IVIG.

Keywords

Immune thrombocytopenia Children Intravenous immunoglobulin Prognostic factor Thrombocytopenia-free survival 

Notes

Conflict of interest

The authors declare that there are no competing financial interests.

References

  1. 1.
    Cooper N, Bussel J. The pathogenesis of immune thrombocytopenic purpura. Br J Haematol. 2006;133:364–74.PubMedCrossRefGoogle Scholar
  2. 2.
    Kalpatthi R, Bussel JB. Diagnosis, pathophysiology and management of children with refractory immune thrombocytopenic purpura. Curr Opin Pediatr. 2008;20:8–16.PubMedCrossRefGoogle Scholar
  3. 3.
    Buchanan GR, Adix L. Outcome measures and treatment end points other than platelet count in childhood idiopathic thrombocytopenic purpura. Semin Thromb Hemost. 2001;27:277–85.PubMedCrossRefGoogle Scholar
  4. 4.
    Yong M, Schoonen WM, Li L, Kanas G, Coalson J, Mowat F, et al. Epidemiology of paediatric immune thrombocytopenia in the General Practice Research Database. Br J Haematol. 2010;149:855–64.PubMedCrossRefGoogle Scholar
  5. 5.
    Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009;113:2386–93.PubMedCrossRefGoogle Scholar
  6. 6.
    Gobert D, Bussel JB, Cunningham-Rundles C, Galicier L, Dechartres A, Berezne A, et al. Efficacy and safety of rituximab in common variable immunodeficiency-associated immune cytopenias: a retrospective multicenter study on 33 patients. Br J Haematol. 2011;155:498–508.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Bussel JB, Saleh MN, Vasey SY, Mayer B, Arning M, Stone NL. Repeated short-term use of eltrombopag in patients with chronic immune thrombocytopenia (ITP). Br J Haematol. 2013;160:538–46.PubMedCrossRefGoogle Scholar
  8. 8.
    Kashiwagi H, Tomiyama Y. Pathophysiology and management of primary immune thrombocytopenia. Int J Hematol. 2013;98:24–33.PubMedCrossRefGoogle Scholar
  9. 9.
    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.PubMedGoogle Scholar
  10. 10.
    Fujisawa K, Iyori H, Ohkawa H, Konishi S, Bessho F, Shirahata A, et al. A prospective, randomized trial of conventional, dose-accelerated corticosteroids and intravenous immunoglobulin in children with newly diagnosed idiopathic thrombocytopenic purpura. Int J Hematol. 2000;72:376–83.PubMedGoogle Scholar
  11. 11.
    Fujisawa K. Intergroup guideline for management of childhood ITP and evaluation of the guideline. Rinsho Ketsueki. 2004;45:428–35.PubMedGoogle Scholar
  12. 12.
    Shirahata A, Ishii E, Eguchi H, Okawa H, Ohta S, Kaneko T, et al. Consensus guideline for diagnosis and treatment of childhood idiopathic thrombocytopenic purpura. Int J Hematol. 2006;83:29–38.PubMedCrossRefGoogle Scholar
  13. 13.
    Treutiger I, Rajantie J, Zeller B, Elinder G, Rosthöj S, NOPHO ITP Working Group. Initial management of children with newly diagnosed idiopathic thrombocytopenic purpura in the Nordic countries. Acta Paediatr. 2006;95:726–31.PubMedCrossRefGoogle Scholar
  14. 14.
    Imbach P, Kühne T, Müller D, Berchtold W, Zimmerman S, Elalfy M, et al. Childhood ITP: 12 months follow-up data from the prospective registry I of the International Childhood ITP Study Group (ICIS). Pediatr Blood Cancer. 2006;46:351–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Ahmed I, Rajpurkar M, Thomas R, Chitlur M. Initial lymphocyte count and the development of persistent/chronic immune thrombocytopenic purpura. Pediatr Blood Cancer. 2010;55:508–11.PubMedCrossRefGoogle Scholar
  16. 16.
    Kato S, Tachikawa T, Ozawa K, Konno M, Okuda M, Fujisawa T, et al. Urine-based enzyme-linked immunosorbent assay for the detection of Helicobacter pylori Infection in children. Pediatrics. 2001;107:E87.PubMedCrossRefGoogle Scholar
  17. 17.
    Okuda M, Fukuda Y. Helicobacter pylori infection in childhood. Nihon Rinsho. 2009;67:2239–44.PubMedGoogle Scholar
  18. 18.
    Donato H, Picón A, Martinez M, Rapetti MC, Rosso A, Gomez S, et al. Demographic data, natural history, and prognostic factors of idiopathic thrombocytopenic purpura in children: a multicentered study from Argentina. Pediatr Blood Cancer. 2009;52:491–6.PubMedCrossRefGoogle Scholar
  19. 19.
    ElAlfy M, Farid S, Abdel Maksoud A. Predictors of chronic idiopathic thrombocytopenic purpura. Pediatr Blood Cancer. 2010;54:959–62.PubMedGoogle Scholar
  20. 20.
    Ho WL, Lee CC, Chen CJ, Lu MY, Hu FC, Jou ST, et al. Clinical features, prognostic factors, and their relationship with antiplatelet antibodies in children with immune thrombocytopenia. J Pediatr Hematol Oncol. 2012;34:6–12.PubMedCrossRefGoogle Scholar
  21. 21.
    Watts RG. Idiopathic thrombocytopenic purpura: a 10-year natural history study at the children hospital of Alabama. Clin Pediatr (Phila). 2004;43:691–702.CrossRefGoogle Scholar
  22. 22.
    Glanz J, France E, Xu S, Hayes T, Hambidge S. A population-based, multisite cohort study of the predictors of chronic idiopathic thrombocytopenic purpura in children. Pediatirics. 2008;121:e506–12.CrossRefGoogle Scholar
  23. 23.
    Stasi R, Evangelista ML, Stipa E, Buccisano F, Venditti A, Amadori S. Idiopathic thrombocytopenic purpura; current concepts in pathophysiology and management. Thromb Haemost. 2008;99:4–13.PubMedGoogle Scholar
  24. 24.
    Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010;115:168–86.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society of Hematology 2014

Authors and Affiliations

  • Yoshihito Morimoto
    • 1
  • Nao Yoshida
    • 1
  • Nozomu Kawashima
    • 1
  • Kimikazu Matsumoto
    • 1
  • Koji Kato
    • 1
  1. 1.Department of Hematology and Oncology, Children’s Medical CenterJapanese Red Cross Nagoya First HospitalNagoyaJapan

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