Splenectomy-sparing, long-term maintenance with anti-D for chronic immune (idiopathic) thrombocytopenic purpura: the New York Hospital experience.

Overview

For nonsplenectomized children and adults with chronic or acute immune (idiopathic) thrombocytopenic purpura (ITP), anti-D has been shown to be a safe and effective treatment, providing hemostatic platelet increases in more than 70% of patients. Children had the best results, but all patient groups responded. In our recently published series, the effect of anti-D therapy lasted for more than 21 days in 50% of the responders and for more than 1 month in 37%. The use of anti-D as maintenance therapy was evaluated in a subset of patients. Of those who responded to the initial anti-D infusion, 79 patients (44 children, 35 adults) received 3 consecutive treatments. There were no significant differences in the responses after each infusion. Fifty-eight patients responded to all 3 treatments; of those, 20 (9 children, 11 adults) continued anti-D therapy, receiving an average of 18 infusions each (range, 10 to 36). The overall response rate was 86%. The ease of administration, duration of effect, and infrequent development of tachyphylaxis make anti-D an attractive alternative for maintenance therapy, particularly for children with ITP who have a high rate of spontaneous remissions. Use of anti-D as a means of spearing the spleen or, at least, postponing splenectomy should now be considered as a clinical option in the management of adult patients with chronic ITP.