Failure of pulse high-dose dexamethasone in chronic idiopathic immune thrombocytopenia

Idiopathic thrombocytopenic purpura (ITP) is a disorder characterized by increased platelet destruction in the setting of normal megakaryopoiesis. Approximately 20% of patients with ITP are refractory to corticosteroids and splenectomy. Recently, pulse high-dose dexamethasone was reported to be effective in the treatment of chronic ITP in adult patients, We treated 9 patients with severe chronic LTP with monthly high-dose dexamethasone, None of the 9 patients responded with a sustained increase in platelet count, Five of these patients were unable to tolerate the regimen, The failure of high-dose dexamethasone in our hands contrasts with the good results of an earlier publication and suggests that there could be a subset of responders who will require better identification. (C) 1997 Wiley-Liss, Inc.