Treatment of Refractory ITP Patients
Third Line Treatment- Aggressive Chemotherapy.
**Please note! The treatment approach described here is based on the author's experience and biases; other physicians who approach the treatment of refractory ITP differently may not be incorrect. The drug doses listed in some of the sections represent those commonly prescribed. However, drug doses in individual patients may differ from those listed here and depend on the patient's clinical situation and the doctor's preferences. Decisions on the treatment of individual patients with ITP are the sole responsibility of the treating physician.
These treatments are reserved for patients who either: (1) fail the previously described therapies or (2) have such severe bleeding symptoms that aggressive treatment is needed. Usually, patients are treated with a course of therapy every 4-6 weeks and a total of 3 to 6 courses is given. Only a small number of patients have been treated with this aggressive form of therapy. However, several of these patients have attained normal platelet counts which have persisted for months to years with no further treatment for their ITP. Side effects may be substantial and the risk is greater. Since the protocols and doses may vary among physicians, details concerning the drugs, doses, and side effects should be discussed with your doctor.
High-dose cyclophosphamide. High doses of cyclophosphamide are given by vein.
Combination chemotherapy. With this treatment, a combination of drugs is given in high doses (e.g., cyclophosphamide, steroids and one or more other chemotherapeutic agents).
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