Combination therapy for refractory XXXX in adolescents.

@entity1667 @entity1 @entity205 @entity1897 @entity1891 @entity3039
PURPOSE: To investigate combined immunosuppressive therapy with @entity1891 , @entity1667 , and prolonged @entity205 in adolescents with refractory @entity3039 ( @entity3039 ). @entity1 AND METHODS: Ten adolescent @entity1 with @entity3039 refractory to previous medical management, including gluco-corticosteroid, intravenous immunoglobulin or anti-Rh (D) IgG, or splenectomy, were treated with combination immunosuppressive therapy at the University of Michigan between 1997 and 2001. Therapy consisted of weekly doses of @entity1891 1.5 mg/m intravenous push (IVP) (maximum dose 2 mg), weekly @entity1667 100 mg/m IVP, and @entity205 (CSA) 5 mg/kg orally twice daily (goal: CSA trough of 100-200 mg/mL). @entity1891 and @entity1667 were given weekly until the platelet count was greater than 50,000/mm for a minimum of 2 doses and a maximum of 4 doses. CSA was continued until the platelet count was normal for 3 to 6 months. RESULTS: Seven @entity1 had continuous complete responses (platelet count normal after cessation of CSA), a median of 13 months (9-37 months) since completion of therapy. One @entity1 had a partial response (platelet count 80-120 x 10 /L off CSA for 3 months). Two @entity1 were nonresponders (platelet count <40 x 10 /L), one of whom had all therapy discontinued after 2 weeks due to @entity1897 . The median time to response was 7 days (range 7-67 days). CSA was administered for a median of 4 months (range 0.5-19 months). CONCLUSIONS: A combination immunosuppressive approach that includes prolonged @entity205 therapy may be promising for refractory @entity3039 and is associated with sustained disease remissions in some @entity1 .
