We read with interest the letter by Emilla et al.1 describing long-term results of low dose cyclosporine in idiopathic thrombocytopenic purpura (ITP). It would have been interesting to know in how many patients was cyclosporine used so that the overall response rates could be known. There are anecdotal reports using Cyclosporin for chronic ITP with various doses.1–7 The overall response to cyclosporine was found in 40–55% of patients. Many patients remained dependent on cyclosporine. We would like to share our experience of therapy with cyclosporine in a large cohort of patients with chronic ITP in both adults and children.
Patients and method: This study is a prospective study of chronic ITP patients treated with cyclosporine at our centre from July 2004 to December 2005. The diagnosis of ITP was based on the presence of thrombocytopenia with normal or increased megakaryocytes in a morphologically normal marrow. Inclusion criteria were: Patients with platelet counts < 30,000/uL or more if they were bleeding, normal renal and liver function, failure of treatment with steroid, splenectomy, or other drugs. Cyclosporine was given as a single agent. Patients were also off another therapy for at least 2 weeks prior to trial. Secondary causes of thrombocytopenia such as systemic lupus erythematosus, lymphoproliferative disorders and HIV infection was excluded.
Cyclosporin was used in the dose of 5 mg/kg/d in two divided doses for 1 week and then reduced to 3 mg/kg/d to maintain serum level between 200–400 ng/mL. Follow-up was done biweekly with platelets counts, liver and renal function test. In patients with response, cyclosporin was continued for period of 6 months and cyclosporin was stopped in patients failing to respond at the end of 3 months. Complete response (CR) was defined as platelet counts of >100x10/L or more for at least 2 months; partial response (PR) defined as doubling of platelet counts from initial level and more than 50x10/L for at least 2 months and no response if platelets counts remained less than 50x10/L.
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