Treatment of acute promyelocytic leukemia with all-trans retinoic acid during the third trimester of pregnancy

✍ Scribed by Reiko Watanabe; Shinichiro Okamoto; Takanori Moriki; Masahiro Kizaki; Yoko Kawai; Yasuo Ikeda

• Publisher: John Wiley and Sons
• Year: 1995
• Tongue: English
• Weight: 240 KB
• Volume: 48
• Category: Article
• ISSN: 0361-8609
• DOI: 10.1002/ajh.2830480320

✦ Synopsis

Response to "Treatment of Childhood Chronic ITP"

Prompted by recent correspondence in the Journal (July 1994), may I contribute the experience from this center in the use of megadose prednisone for chronic immune thrombocytopenic purpura (ITP) in children?

A cohort of 4 children received this regimen, representing all of those who fulfilled the eligibility criteria at that time (November 1992).Thus, all had platelet counts of less than 50 X 109/1 for longer than 6 months, and all were symptomatic with mucosal and/or skin manifestations of bleeding. No child had undergone splenectomy, but each had failed some form of accepted therapy for ITP (see Table I).

All families agreed to the megadose steroid regimen which was administered identically to each child: oral prednisone 30 mglkglday for 3 days, then 20 mg/kg/day for 4 days with progressive reduction and completion of therapy in the second week. The drug was given in divided doses and resulted in prompt normalization of the platelet count in all children.

However, each child then relapsed and all experienced severe toxicity with marked behavioral abnormalities (including striking irritability, violent outbursts, and distressing disturbance of sleep). All families described the experience as profoundly negative, and we have abandoned this approach as an elective treatment strategy.

The durability of response and remarkable lack of toxicity with megadose steroid therapy, as reported by colleagues from Turkey [l], must be evaluated in the recognition of the limited follow-up undertaken in that context [2,3]. Megadose prednisone is manifestly not the simple remedy for chronic ITP in childhood. Whether dexamethasone offers an appreciable advantage, as has been suggested recently [4], and as may be the case in acute lymphoblastic leukemia [5], remains to be addressed in a properly designed, randomized clinical trial [6].