联合化疗治疗成人慢性难治性特发性血小板减少性紫癜

Long-term outcomes of combination chemotherapy in adult chronic refractory idiopathic thrombocytopenic purpura

目的评价小剂量联合化疗对难治性特发性血小板减少性紫癜（TIP）的疗效及安全性。方法回顾性分析应用小剂量联合化疗31例成人难治性TIP患者的临床资料,并进行长期随访。结果31例患者中13例（41.9%）完全缓解（血小板≥100×10^9/L）;9例（29.0%）部分缓解（血小板〉50×10^9/L）;9例（29.0%）未缓解（血小板〈50×10^9/L）。联合化疗有效率为71.0%。3例失访;在28例获得随访患者中12例（42.9%）完全缓解,7例（25.0%）部分缓解,9例（32.1%）未缓解,联合化疗有效率为67.9%。28例中有10例完全缓解和3例部分缓解的患者在未接受其他治疗的情况下到随访结束时仍持续缓解,其中4例持续缓解超过60个月,5例超过36个月,1例超过12个月,3例少于12个月（分别为3月、6月和9月）。在随访患者中,有4例在化疗数月后因持续的血小板减少而导致中枢和/或胃肠道出血而死亡。结论对于糖皮质激素和脾切除治疗无效的某些难治性TIP患者,小剂量联合化疗可能不失为一种有效的治疗方法。

Objective To explore the treatment outcome and safety of low dose combination chemotherapy in refractory idiopathic thrombocytopenic purpura （ ITP ）. Methods Clinical data of 31 patients with chronic refractory ITP treated with low dose combination chemotherapy were retrospectively analyzed and long-term followed-ups were taken in 28 cases. Results Among the 31 patients, 13 （41.9%） had complete responses （platelet count 〉 100 ×10^9/L） ; 9（29.0% ） had partial responses （platelet count 〉 50 ×10^9/L） ; 9 （29.0%） had no response （ platelet count 〈50 ×10^9/L）. The overall response （ CR ＋ PR） rates of combination chemotherapy were 71.0%. In the 28 follow-up patients,12 patients （42.9%） had CR[7 patients （25.0%） had PR] and 9 patients （32.1%） had no response, The overall response rate was 67.9%, Of 28 patients, 10 with complete remission and 3 with partial remission had persisting remissions without further therapy until the last follow-up. Of them 4 patients had remissions lasting more than 60 months ,5 patients more than 36 months, 1 more than 12 months and only 3 patients less than 12 months （3,6 and 9 months, respectively）. Four patients died a few months later as a result of intracerebral or/and gastrointestinal bleeding due to unremitting thrombocytopenia. Conclusion Low-dose combination chemotherapy is beneficial in some patients in whom ITP is refractory to corticosteroids and splenectomy.